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T HE CHILD IN HEALTH AND ILLNESS 
CARL G. LEO-WOLF, M.D. 



Medicine, being a progressive science, does not recognize 
the words "always" and "never." 




II I . \ < KM li l\ II I. \l I II 



THE CHILD 

[N HEALTH AND 

ILLNESS 



BY 

CARL G. LEO-WOLF, M.D 



ILLUSTRATED 




NEW YORK 
GEORGE H. DORAN COMPANY 






COPYRIGHT, 1917, 
BY GEORGE H. DOUAN* COMPANY 



SEP 15 1917 



PRINTED IN TnE rNTTED STATES OF AMERICA 



77 



DEDICATED TO 

THE MOTHER 

OF MY CHILDREN 



PREFACE 

The author has attempted in this book to collect 
as much as possible what he considered every 
mother should know about her child and its bringing 
up, in health as well as in illness. If he has gone 
more into detail on some subjects and brought less 
on others, this is based on his experience of over 
twenty years, first as a general practitioner and of 
late as a children's specialist. Thus, for instance, 
some mothers may be disappointed that he has not 
gone more specifically into the feeding of infants; 
but as he holds, and as he believes rightly, that this 
should be left entirely in the hands of the physician, 
he would have been inconsequent if he had not re- 
frained from going into details. On the other hand, 
he has given the recipes mostly used nowadays in 
feeding infants, so that the mother can follow these 
in carrying out the physician's directions. 

The book has been evolved from a series of lec- 
tures to nurses which has been given by the writer 
at different hospitals during the last fifteen years or 
more, and which have been revised from year to 
year. 

Some of the contents of this book have been taken 
from books written by different authors, both here 
and abroad, and the author takes this opportunity 
to acknowledge his indebtedness to them. 



Vll 



Vlll 



PREFACE 



The introductory pages, on the prenatal infln 
ence and care, have been kindly contributed by D: 
Peter W. Van Peyina and the chapter on the eyes b 
Dr. F. Park Lewis, to both of whom the autho 
wishes to express his sincerest thanks. 

So this book now goes forth and if it succeeds i] 
lessening a mother's anxiety, if it will make it easie: 
for her to raise her children and to see them gro^v 
up into healthy men and women, then its missioi 
will be fulfilled. 

The illustrations for this book are mostly fron 
original photographs taken by my friend, Dr. E. A 
Sharp, at the German Deaconess Hospital and a 
Our Lady of Victory Infants y Home; some hav< 
been furnished by friends; the cuts were providec 
by Best & Co. and the Jeffrey-Fell Co., others again 
are copies from books. 

To all those who have kindly helped me I here- 
with express my sincerest thanks. 

June, 1917. 
481 Franklin Street, 
Buffalo, N. Y. 



CONTENTS 

RENATAL INFLUENCE AND CARE paqb 

by Dr. P. W. Van Peyma ..... 15 

APTER 

I. The Development of the Infant ... 24 

II. Diseases of the Newborn 34 

III. The Care of the Newborn 37 

IV. The Care of the Infant 45 

V. The Feeding of Infants: 

Breast-feeding 65 

Wet-nursing 80 

Difficulties in Breast-feeding 85 

Combined Feeding 89 

Weaning 90 

Unnatural Feeding 93 

VI. The Digestive Disturbances of Infants: 

Explanation 105 

The Treatment 109 

VII. Teething 112 

III. The Premature Infant 115 

IX. The Diseases of Infancy 122 

X. The Development of the Child'. . . . 138 

XI. The Feeding of Children 142 

£11. The Clothing of Children . ... . 154 

« 



x CONTENTS 

CHAPTEB PAQB 

XIII. The Education of the Child .... 158 

XIV. The Infectious and Contagious Diseases 

of Childhood: 

Their Prevention 171 

Special Protection Against Infectious Diseases: 

Vaccination 178 

Inoculation Against Other Diseases . . 184 

Their Recognition 187 

Their Complications 209 

Their Care 213 

XV. Other Diseases of Childhood .... 219 

XVI. Defects of the Eye and Blindness in Chil- 
dren, b}' Dr. F. Park Lewis .... 252 

XVII. Household Remedies and Measures . . 267 

XVIII. Recipes of Dishes for Children . . . 280 

Index 291 



ILLUSTRATIONS 

H Frontispiece 

UBE PAGE 

1 Relation of size of the head to the rest of the body 28 

2 The fontanels 28 

3 Bath-thermometer 40 

4 Newborn being put into bath 40 

5 Newborn being held in bath 40 

6 Newborn with cord wrapped in gauze and binder 
about to be applied 40 

7 Old-fashioned way of putting on diaper ... 46 

8 New method of putting on diaper 46 

9 Pad over diaper 46 

Baby clothes 48 

1 Baby clothes without pins or buttons, and shaped 
diaper 50 

2 Sleeping bag 50 

3 Night gown 50 

4 Clothes-basket as bed 54 

5 Iron bed 54 

6 Hammock 56 

17 Willow baby-buggy 56 

L8 High chair 56 

L9 Walking pen 56 

20 Nursery 58 

• 



xii ILLUSTRATIONS 

FIGURE PAGE 

21 Baby cariole 58 

22 How to carry young infant 62 

23 How to carry older infant 62 

24 How to nurse baby in bed 68 

25 How to nurse baby sitting 68 

26 Breast shield 76 

27 Breast pumps 76 

28 Scales of Buffalo Scale Co., No. 800, Special . . 82 

29 Scales of Fairbanks Co., Platform Scoop Scale . 82 

30 Scales of Fairbanks Co., Scoop Scale .... 82 

31 Three day nursing record 90 

32 Nursing bottles with nipples 98 

33 How to keep food 98 

34 Ice box 102 

35 Electric bottle heater 102 

36 Automatic incubator 116 

37 Improvised incubator ........ 116 

38 Movable incubator 118 

39 Breck feeder 118 

40 Gauze mask 130 

41 Eczema cuff 130 

42 Eczema cuff applied 130 

43 Rompers 154 

44 Bloomer dress 154 

45 Suspenders 154 

46 Night drawers 154 

47 Pyjamas 156 

48 Winter clothing 156 



/ 



HMHB 



ILLUSTRATIONS xiii 

FIGURE PAGE 

Shoes 156 

Waist for young girls 156 

Hot water plate for young child 164 

Eating utensils for children . . . . . . . 164 

Vaccination, first day 182 

Vaccination, eighth day 182 

Vaccination, eleventh day 182 

Vaccination scar . 182 

Hospital bed 216 

Wool truss 216 

Soap suppository ; • • • 268 

Fever thermometer . . . :'. . '. ;. . . 268 

Bronchitis kettle . . . . . . . "~\ ' . . 270 

Improvised bronchitis kettle . . \ . . . 270 

Steam tent . . . ' . 270 

Wet compress on baby . . < . . . . . . 272 

Wet compress for older child ... . . . 272 

Filling hot water bag 274 

Enema 276 

Wet pack 278 

Daily weight chart . . . . See End of Volume 
Weekly weight chart, first year . 
Weekly weight chart, second year 
Weight chart, from first to fifteenth 

CC (C CI cc 

year 



a a cc a 

cc a tc cc 



THE CHILD IN HEALTH AND ILLNESS 



THE CHILD IN HEALTH 
AND ILLNESS 

PRENATAL INFLUENCE AND CARE 

BY PETER W. YAK PEYMA, M.D. 

Clinical Professor of Obstetrics, University of Buffalo, N. F., Medical Department 

EVERY prospective mother should know that the 
care of the infant does not begin at the time of 
its birth. It extends back to the beginning of preg- 
nancy. In a certain sense it may even be said that it 
goes back to its ancestry, for the health and vigour 
of the child's parents and ancestors are definite and 
important elements in the constitution and viability 
of the infant. The influences of heredity for good 
or evil are so certain that no man or woman should 
marry and have children without having good 
reason to believe that the offspring will start life 
with a fair chance of good health. In cases of doubt, 
the opinion of an intelligent and conscientious phy- 
sician should be sought. 

As soon as a woman recognises that she is preg- 
nant she should place herself in the care of her med- 
ical advisor. The progress of pregnancy and labour 
should be, and is generally, physiologically normal, 

15 



16 THE CHILD IN HEALTH AND ILLNESS 

yet there are many possible occurrences that may be 
serious, and that require immediate and intelligent 
attention. A woman who goes through the whole 
period of pregnancy without the supervision of a 
physician takes many risks, and may have very seri- 
ous developments. 

The rules which the pregnant woman should ob- 
serve are, in general, those which every one needs 
to follow in order to maintain health. Only in spe- 
cial circumstances will particular requirements be 
found necessary. While due care and attention 
should always be observed excessive mental pre- 
occupation is harmful. To be constantly thinking 
about one's health is at all times prejudicial. Dur- 
ing pregnancy also this should be avoided. Above 
all, apprehension and worry as to one's condition 
should be guarded against. A fairly normal woman, 
under competent medical supervision, should pass 
through pregnancy and labour in a state of serene 
and hopeful confidence. 

In fairly normal circumstances, it is a general rule 
that what is good for the prospective mother is good 
for the unborn infant. 

With these few prefatory remarks, we may now 
take up the special conditions that need careful 
attention. 

It is not generally known that the development of 
the child during the first three months is very rapid. 
By the end of the third month the various organs of 
the infant are formed. During the following months 
they simply grow in size. During the later months, 



PRENATAL INFLUENCE AND CARE 17 

also, the child as a whole grows in size and weight 
and there is especially development of bone and fat 
tissue. 

It is particularly during the first three months 
that miscarriages are most likely to occur. For the 
above reasons especial care should be observed dur- 
ing the early period. Violent exercise, heavy lifting, 
jumping, slipping and falling, fatiguing and too long 
continued work, long jolting rides on the rear seat 
of an automobile, are all likely to be harmful. Worry 
and all other mental states that tend to lessen gen- 
eral health are also detrimental. 

While the exact evil results of sudden and violent 
emotions have not been positively settled it is best 
to avoid all causes of great excitement. 

A simple, quiet life w r ith a fair amount of recrea- 
tion and mental diversion is best. 

Moderate exercise, with plenty of fresh, pure air, 
deeply breathed, is beneficial. It is, however, a 
great and common mistake to think that the greater 
the amount of exercise the better ; that, for example, 
the greater the number of miles walked the better 
for the prospective mother and the easier the com- 
ing labour or confinement. Exercise, to be most help- 
ful, must be enjoyed; should be recreative, should 
be mildly exhilarating. 

The house, and especially the bedroom, should be 
well ventilated. The sleeping room should be cool, 
the bed clothing sufficient to keep warm. The cloth- 
ing by day should be comfortable without any undue 
pressure or constriction. Corsets that constrict the 



18 THE CHILD IN HEALTH AND ILLNESS 

waist should never be worn. They are particularly 
harmful to the pregnant woman. Maternity waists 
that support the abdomen properly are sometimes 
advisable. The footwear must be of a kind to keep 
the feet warm and dry. 

During pregnancy the food should be plain, nu- 
tritious, digestible, moderate in quantity. Only in 
special circumstances is a limited diet necessary. 
Limiting the food with the idea of having a smaller 
baby and an easier labour is not to be recommended. 
It has practically no effect except when carried to 
extreme and then is positively harmful to both 
mother and child. 

As a rule, water should be drunk freely, preferably 
before meals. Coffee and tea should be taken spar- 
ingly, if at all. They should be wholly avoided by 
persons of a nervous temperament and by those who 
do not sleep well. Alcoholic beverages should be 
taken only when prescribed by the physician. 

The pregnant woman supplies the needs of the in- 
fant. By means of the placenta, the so-called after- 
birth, and the umbilical cord she furnishes food and 
oxygen to the unborn. At the same time she removes 
the excretions of the infant, such as carbonic acid 
gas, urea, etc. This latter function gives added 
work to her organs of excretion, the lungs, the skin, 
the kidneys, and the liver and intestines. For this 
reason the lungs need plenty of pure air, the skin 
needs to be kept fairly active, care being taken that 
the surface of the body does not become chilled, the 
kidneys need a. certain amount of liquid, including 



PRENATAL INFLUENCE AND CARE 19 

pure water, and the intestines must be kept open. 
The food must not be excessive in quantity, nor too 
rich in quality. Perfect digestion is of the greatest 
importance. 

The nausea and vomiting of pregnancy occur 
most frequently upon arising in the morning and 
are, therefore, sometimes called "morning sick- 
ness." Nausea and vomiting are of common occur- 
rence but vary much in severity and troublesome- 
ness. This disturbance develops usually at about 
the beginning of the second month and frequently 
ceases by the end of the fourth. A sudden change 
from the reclining posture to the erect, as upon aris- 
ing from bed, favours the occurrence. A little black 
coffee with perhaps a little light food an hour before 
arising, with a very gradual change from the reclin- 
ing to the sitting posture, may sometimes prevent it. 
If the condition is severe a physician must be con- 
sulted. 

Careful attention to the teeth is very important. 
Trouble with the teeth is common during pregnancy. 
Rinsing the mouth with an alkaline solution, such 
as, for example, bicarbonate of soda a half teaspoon- 
ful to a glass of water is to be recommended. Minor 
dental work that is not painful is allowable. 

Warm baths may generally be taken regularly, 
care being taken not to become chilled afterwards. 
Vapour baths, cabinet baths, turkish baths, massage, 
etc., while as a rule not objectionable are not ordi- 
narily necessary. 

The condition of the bowels is of the greatest im- 



2 i THE CHILD IN HEALTH AND ILLNESS 

portance. The bowels should move freely once or 
twice daily. Many women suffer from constipation, 
A common cause of this is the neglect and the post- 
ponement, in earlier life, of the calls of nature. In 
course of time the lower bowel becomes accustomed 
to the overdistended condition and inactive in emp- 
tying itself. During the later months of pregnancy 
constipation is generally aggravated, often due to 
the pressure on the lower bowel by the pregnant 
uterus, and by lessened general physical exercise. 
-Much can be done by trying to establish a regular 
time of movements. Laxative fruits and certain 
foods are useful in regulating the bowels. The need 
of laxative and purgative drugs is unfortunate. Still 
in certain cases they may be necessary. Various lax- 
atives are recommended by physicians. A change of 
laxatives is occasionally advisable, as the same drug 
in time loses its effect. The milder the drug the 
better, so long as it is efficient. Enemata are some- 
times useful. 

Due to the extra work imposed upon the liver and 
the kidneys during pregnancy these organs not in- 
frequently fail in their function. This condition 
may become very serious in its consequences by the 
accumulation of excrementitious poison in the blood. 
Fortunately careful examinations of the urine make 
it possible to recognise the danger in time. The 
urine should be examined regularly during the latter 
half of pregnancy. The frequency of examination 
depends upon circumstances. In general every two 



PRENATAL INFLUENCE AND CARE 21 

weeks is sufficiently often. Approaching term, the 
examinations should be made every week. 

There are certain symjDtoms which may be pre- 
monitory of danger. Some of these are severe fron- 
tal headache, blurring or obscurity of vision, recur- 
ring dizziness, puffiness of the face and hands, and, 
sometimes, very severe pain in the pit of the stom- 
ach. When any of these symptoms or any group of 
them occur the urine should be sent for examination 
at once, accompanied by a statement of the symp- 
toms experienced. 

For ordinary purposes a four ounce sample is 
sufficient. In certain cases a twenty-four hour sam- 
ple is required. Care should be taken that nothing 
becomes mixed w^ith the urine. The bottle contain- 
ing it must be perfectly clean. 

Not infrequently the breast-nipples demand some 
attention. The nipples should project sufficiently 
that the newborn infant may be able to take hold and 
nurse. In certain cases where the nipples do not 
project efforts must be made during pregnancy to 
draw r them out. This can often be done by the fin- 
gers making gentle traction, and it can also be done 
by various means of suction such as pipes, heated 
bottles and breast-pumps. The efforts should not 
be too violent nor too long continued at one time. 
There exists an intimate relation through the ner- 
vous system between the breasts and the uterus, and 
too long continued irritation of the nipples may 
cause uterine contractions with possible danger of 
miscarriage. This nervous relation is often shown 



22 THE CHILD IN HEALTH AND ILLNESS 

when nursing causes the contractions called after- 
pains. 

The nipples should be kept scrupulously clean. 
For this purpose a saturated solution of boracic acid 
in pure water is useful. To this solution one quarter 
the amount of pure grain alcohol may advanta- 
geously be added if the nipples are especially soft 
and moist. If, on the contrary, they are very dry and 
scaly a little sterilised cold cream should be applied. 

Miscarriages are of rather frequent occurrence. 
They are most common during the first three months. 
They are due to various causes. The uterus may be 
in wrong position. The most common of the malpo- 
sitions is retroversion or tipping backwards. Cer- 
tain diseases both acute and chronic are common 
causes and require treatment. Some women mis- 
carry habitually. In all such cases the physician 
must be consulted. Upon the occurrence during 
pregnancy of a flow of blood or of recurring pains 
in the back or lower abdomen the patient should at 
once go to bed, keep very quiet and send for a phy- 
sician. 

That the labour mav be normal it is essential that 
the bony pelvis be of normal size and shape. Marked 
deformities are fortunately comparatively rare es- 
pecially among American women. Where there is 
reason for doubt a careful measurement of the pelvis 
should be made early. The fact that a woman has 
had normally one or more full-sized children is the 
1>< st evidence that her pelvis is normal so far as size 
and shape are concerned. 



PRENATAL INFLUENCE AND CARE 23 

The engagement of a competent and conscientious 
nurse should be attended to early. The nurse should 
also be one that is congenial to the patient. 

Whether to remain at home or to go to a hospital 
is a matter of circumstances. In case of remaining 
at home certain preparations as to room, bed and 
various articles should be made in time. 

Finally it is important that during labour a woman 
do her part well. She must be prepared to exercise 
some patience and a fair amount of fortitude. Even 
a normal labour takes some time, and can not safely 
be hurried. This is especially true of most first 
labours. As a rule most harm, to both mother and 
child, is done in being impatient and hurrying the 
labour. 



CHAPTER I 
THE DEVELOPMENT OF THE INFANT 

IT is a common mistake to assume that the infant, 
or the child, is only a small edition of the adult. 
This is by no means the truth, neither in reference 
to its general aspect, nor as to the construction or 
the efficiency of its organs. 

Let us have a good look at the body of the infant 
and we shall perceive at a glance that its arms and 
legs are comparatively short, the abdomen too big, 
the chest barrel-shaped and narrower than the head, 
the head itself overlarge, the neck almost absent. 

When we take correct average measures we find 
that the length of the body of the newborn is four 
times the height of its head (at two years it will be 
five times, at six years, six, at twelve years, seven, at 
twenty-five years, eight times the height of the 
head). (See Fig. 1.) 

We also know that the surface of the body of the 
newborn is in comparison to its weight about three 
times that of the adult, that of the infant at six 
months twice that amount. 

This greater surface of the body of the newborn 
and the infant is of great importance, inasmuch as 
a larger surface will naturally favour a larger loss of 
heat, and this in turn explains why the maintenance 

24 



THE DEVELOPMENT OF THE INFANT 25 

of the body-heat requires considerably more energy 
from the system of the newborn and the infant than 
from that of the adult, and this also explains why 
the demand for energy, or expressing it in a simple 
way, the demand for food, is much larger the 
younger the individual. 

The amount of heat produced by a certain amount 
of food is expressed by the term of "calories," — a 
calory being the amount of heat required to raise 
the temperature of one kilogram of w T ater one de- 
gree centigrade — and we know from experience that 
while the adult requires about 35 calories per kilo- 
gram, that is 16 calories per pound, the newborn in- 
fant requires about 100 to 110 calories per kilogram, 
that is 45 to 50 calories per pound, up to six months 
of age, after which time the required calories di- 
minish in accordance with the lessening relative sur- 
face of the body down to about 90 calories per kilo- 
gram, that is about 40 calories per pound during 
later infancy. 

Of all the newborn in the animal kingdom none is 
quite as helpless as the newborn human being, none 
so entirely dependent upon outside help ; it will re- 
main wherever it is placed, without being able to 
do as much as change its position ; it is devoid of pro- 
tective covering and it will therefore die from cold 
if not provided with clothing. During the nine 
months of its life within its mother's womb it was 
continually surrounded by the even temperature of 
the maternal organism and it received its nourish- 
ment from the mother's blood. Now, all at once, 



26 THE CHILD IN HEALTH AND ILLNESS 

what a sudden change takes place in tlie life of the 
newborn human being. — The temperature of its sur- 
roundings decreases from about 99 degrees Fahren- 
heit to about 67 degrees; the circulation through the 
cord is interrupted by ligation ; it is required to pro- 
vide its system with oxygen through inspiring the 
relatively cold air of the room. It is in need of a 
long refreshing sleep to get over the exhausting and 
unprecedented experience through which it has just 
passed. 

During the first few days of life after birth the 
newborn will lose in weight as a rule, usually from 
3 to 10 ounces. This loss will be made up about the 
middle of the second week. 

The weight of an infant born at term averages 
iy± lbs. for boys and 7 lbs. for girls, though there 
may be considerable variations. In the writer's ex- 
perience newborn babies weigh only very rarely 
more than 9 lbs., provided accurate scales are used. 

TABLE OF WEIGHTS 
Healthy Nursing Infant Weighing at Birth 7M Lbs. 

Gain 
End of Month Weight Per Week Per Day 

1st 8.1 lbs. 

2nd 10.6 lbs. 6H ounces 7J/£ drams 

3rd 12.1 lbs. 6 ounces 6 drams 

4th 13 .6 lbs. 6 ounces 6 drams 

5th 15.0 lbs. 5^2 ounces 5H drams 

6th 16 . 3 lbs. 43^2 ounces 5 drams 

7th 17.4 lbs. 4 ounces ± l /> drams 

8th 18.3 lbs. 7>Yl ounces 3H drams 

9th 19.1 lbs. 3^2 ounces 3 l A drams 

10th 20.0 lbs. 8H ounces 3H drams 

11th 20.9 lbs. 33^ ounces 3 Vi drams 

12th 21.6 lbs. 2V 2 ounces 2Vi drams 



THE DEVELOPMENT OF THE INFANT 27 

A healthy nursing baby should have doubled its 
original weight by the end of the fifth month and 
should have trebled its weight at the end of the first 
year of its life. 

The length of a newborn averages 20 inches; at 
the end of the first year it should measure 28 inches. 

The skin is red and should be smooth; in some 
places, usually on the shoulders and upper arms, it 
is still covered by short curly hair, the so-called 
lanugo. 

The scalp is covered with a considerable amount of 
silky hair, which is usually dark in colour ; this first 
lair will fall out within the next few weeks and will 
3e replaced by the permanent hair, which is some- 
what coarser and frequently of a lighter colour. 

The bones of the skull are ossified, but they can 
3e moved against each other easily and one can 
readily define the borders of each bony plate. Be- 
ween the plates we find the membranous sutures 
md the membranous spots, the so-called fontanels ; 
:>f these latter the anterior one is the larger and 
shaped like a diamond, measuring in its long, an- 
ero-posterior diameter about iy 2 inches ; the trans- 
verse diameter is about one inch; the smaller pos- 
terior fontanel is triangular. (See Fig. 2.) 

The nails are fully formed and reach to or even 
>eyond the ends of the fingers and toes. 

The chest is barrel-shaped and circular in its 
sross-section, but with the further development of 
;he child it becomes flattened in its antero-posterior 
iiameter. The circumference of the chest of the 



28 THE CHILD IN HEALTH AND ILLNESS 

newborn averages 13 inches, and it will thus be 
found to be somewhat smaller than the circumfer- 
ence of the head, which averages 14 inches. Toward 
the end of the first year the circumference of the 
head and the chest will be equal, namely about 18 
inches. 

The mucous membrane, the lining, of the whole 
gastro-intestinal tract, including the mouth, is very 
tender. 

The position of the stomach is a vertical one, and 
only later in life will it gradually assume the more 
horizontal position which we find it to have in the 
adult. This fact explains why infants spit up part 
of their food so readily, as this is simply a running 
over of the overfilled or irritated organ. This spit- 
ting up of food is always a sign that something is 
wrong either with the food or the feeding, and it is 
never observed in entirely w r ell babies, except if a 
baby is allowed to lie on its left side immediately 
after nursing, when the heavy liver will press on the 
full stomach. 

The intestines are still deficient in elasticitv and 
their muscular coat is not well developed. The 
length of the intestine in the infant is six to eight 
times that of the length of its body; in the adult it is 
four and one-half to five times the length of the 
body. The inner surface of the intestine of the in- 
fant is also larger and its absorbing apparatus more 
abundant. The reason for this can easily be found 
in the greater amount, relatively speaking, of work 
demanded from the digestive tract and also of the 




At Birth 2 Yrs. 6 Yrs. 

FIGURE 1. RELATION OF STZE OF THE HEAD TO THE REST OF THE BODY 




Figure 2. the fontanels 






th\ 




?m **m Com 

At Birth 2 Yrs. 6 Yrs. 12 Yrs. 

FIGURE 1. RELATION OF STZE OF THE HEAD TO THE REST OF THE BODY 




Figure 2. the fontanels 



THE DEVELOPMENT OF THE INFANT 29 

digestive" glands of the infant. For instance, the 
liver, the largest of these digestive glands, will 
weigh in the infant one-eighteenth of the weight of 
the whole body, in young adults one-thirtieth, and 
in old age one-fiftieth of the w r eight of the whole 
body. 

The umbilical cord consists of three blood-vessels, 
two arteries and one vein, which were the only means 
of nourishing the child in its mother's womb; these 
are surrounded by a jelly-like mass. Through the 
umbilical arteries the infantile heart had been pump- 
ing the used-up blood back into the afterbirth, where 
the blood is cleaned and reloaded with those sub- 
stances which are essential and indispensable for the 
life of the young growing organism, to be sent back 
to the child through the single umbilical vein. Un- 
der normal conditions the stump of the umbilical 
cord dries up within a few days and falls off spon- 
taneously about the fifth or sixth day of life ; at this 
site we will then find an ulcer which will be covered 
with skin in another eight days; until this process 
of healing is completed we call the child a newborn. 

The urine is colourless except during the first four 
days, when it will be found to contain a considerable 
amount of a reddish substance which leaves a stain 
in the diaper. The urine is usually voided twice to 
each feeding and the daily amount of urine passed 
by the child is two-thirds of the amount of liquid it 
has taken. 

The stools of the first two days of life consist of 
a greenish-black sticky substance called meconium. 



3 o THE CHILD IN HEALTH AND ILLNESS 

By the end of the second or the beginning of the 
third day the first breast-stool will be voided. These 
stools are of a golden-yellow colour, thick, pasty; 
they look like scrambled eggs ; their odour is slightly 
acid, aromatic and by no means disagreeable. Stools 
are usually voided twice a day. Should the infant 
pass his stools more frequently, should they be thin, 
greenish and mixed with white flakes, and should 
they be passed with pressing or squirted out, then 
this will be a sure sign of a disturbance of digestion, 
and the attention of the physician should be called 
at once to this condition. 

During the first few weeks of life the infant moves 
but very little ; it sleeps most of the time and is thus 
enabled to conserve a considerable amount of en- 
ergy; but inasmuch as motion means also a produc- 
tion of heat, it will thus miss a source for the pro- 
duction of heat which will be quite considerable later 
in life. The principal physical exercise of the new- 
born is the crying, by which it may use up a con- 
siderable amount of energy. I wish to state how- 
ever right here that the crying in infants is but 
rarely the expression of a desire for more food, but 
that, on the contrary, most babies cry because they 
have stomach-ache, owing to the overfilled condition 
of this organ. The first motions of the newborn are 
involuntary and automatic. About the end of the 
second month the infant will attempt to lift up its 
head, but it cannot keep its head up when being car- 
ried around until the fourth month, when it will also 
make its first attempts at grasping things volun- 



THE DEVELOPMENT OF THE INFANT 31 

tarily; it will try to sit up at five months. At six 
months it will begin to crawl around when placed 
on the floor ; with about nine months it will get up 
on its feet and it will then soon be able to walk 
around a chair. The child will begin to walk really 
only after the completion of the first year. 

The first smile of the baby will be observed about 
the middle of the sixth week. 

The eyes of the newborn must get accustomed 
quite gradually to the transition from the absolute 
darkness before its birth to the bright sunlight of 
the outer world. For the first two weeks the in- 
fant seems to suffer considerably from the effect of 
bright light. The movements of the eyes are at 
first inco-ordinate ; the eyeballs are not moved sym- 
metrically; therefore a squint at this time or the 
turning of the eyeballs during sleep is, usually, with- 
out serious significance and should not give rise to 
alarm. The infant will begin to fix and to follow 
bright objects when it is six weeks old. Tears put 
in appearance usually during the third month. 

The newborn is deaf. Usually during the third or 
fourth week it will begin to perceive loud noises; 
it will turn its head toward the source of sound only 
after it is two months old. 

The healthy infant should sleep almost continu- 
ously during the first four or six weeks, waking up 
only for its feeding ; during the next months it should 
be awake only during an occasional half -hour. La- 
ter on when we come to the feeding of young in- 



32 THE CHILD IN HEALTH AND ILLNESS 

fants I hope to show how easy it is to train infants 
from the very first clay of life to wake up for their 
food at regular intervals and how they will thus give 
very little trouble to their mother or attendant. 

The closing of the large fontanel should be com- 
pleted by the tenth to twelfth month ; delayed closing 
is a sign of something being wrong. 

The first of the milk-teeth, the two lower middle in- 
cisors, appear at six months of age ; during the next 
six to eight weeks the two upper middle incisors will 
put in appearance ; then the upper external incisors, 
and during the tenth to twelfth months the lower 
external incisors ; thus a child of twelve months 
should have eight milk-teeth, and by the end of the 
second year it should possess all its milk-teeth, twen- 
ty in number. An easy way to remember the order 
of eruption of the milk-teeth is the following scheme, 
in which the arabic figures denote the order of their 
appearance and the Eoman figures the months: 



XXI 


to 


XXIV 




XII 


XVII 


to 


XX 


XVI 








to 








9 


13 


VI to XII 


14 


10 




17 


5 3 


4 6 


18 


19 


11 


15 


7 1 


2 8 


16 


12 


20 



THE DEVELOPMENT OF THE INFANT 33 

The newborn has a pulse-rate of about 135 (130 
to 160) a minute and breathes at the rate of about 
35 (30 to 60) respirations per minute; this is about 
twice as much as in the adult. By the end of the 
first year the pulse-rate will be 120 and the respi- 
rations 25 to 30 per minute. Irregularities in this 
rate in young infants should not cause any alarm, as 
they may be due to crying or temper or other slight 
provocations. 

The temperature of the newborn in health taken 
in the rectum is 99.3 degrees Fahrenheit. In the 
premature it is lower, as will be explained later. 



CHAPTER II 
DISEASES OF THE NEWBORN 

JAUNDICE of the newborn is not a disease, prop- 
erly speaking, as it is found in at least eighty out 
of one hundred healthy newborn infants, but if it 
should persist later than the end of the first week, 
the physician should be called, as this might indicate 
some serious trouble. The yellow discolouration of 
the skin and the white of the eyes begins usually on 
the second day after birth, to disappear again with- 
in a few days. 

Some newborn do not breathe properly nor cry 
lustily after birth; this happens mostly after diffi- 
cult or instrumental labour, or, their lungs fail to ex- 
pand entirely, which is mostly observed in prema- 
ture infants. These children demand the constant 
supervision of a trained nurse for some days, and 
the physician should at once be called to employ the 
necessary measures to obviate these conditions. 

A relatively rare and a serious condition in the 
newborn is one in which blood is vomited and passed 
with the stools, with the consequent weakening of 
the child ; the best because most successful treatment 
for this is the introduction of human blood, usually 
of its father, into the circulation of the baby. 

34 



DISEASES OF THE NEWBORN 35 

On the second or third day after birth we will 
observe in almost all newborn, regardless of the sex 
of the child, a swelling of the breast-glands, some- 
times accompanied by a discharge, the so-called 
"witch's milk" ; this wall reach its height around the 
tenth day and disappear completely in the third or 
fourth week. This condition must be left entirely 
alone, beyond applying a light protective dressing to 
avoid injury and infection. 

Infection of the navel is the most frequent as well 
as the most serious disease of the newborn. "When- 
ever the navel does not look quite normal or shows 
an abnormal discharge, or when its healing is de- 
layed the physician should be called at once. The 
utmost care and cleanliness in the handling of the 
cord can usually prevent this infection. 

The physician should also be informed at once of 
any redness of or discharge from the eyes of the 
newborn because of the serious results so frequently 
following an infection of the eyes during the act of 
birth or soon after — an infection which is responsi- 
ble for the loss of sight in one-third of all the blind 
children under ten years of age. 

Once this disease has been allowed to develop, 
only the most painstaking care, the most constant 
and conscientious carrying out of the physician's 
orders, by day and by night, may be able to save the 
child's eyesight. 

Luckily we have an easy means to prevent this 
infection by simply placing a few drops of a disin- 



36 THE CHILD IN HEALTH AND ILLNESS 

fecting solution between the child's eyes immedi- 
ately after its first bath. 

In a large number of states and countries this pre- 
ventive treatment must be used by physicians and 
mid-wives, with the happiest results, and some 
states, as for instance the State of New York, and 
also some cities furnish solution and dropper, ready 
for use, free of charge. 



CHAPTER in 
THE CARE OF THE NEWBORN 

WITH the tying and cutting of the cord the birth 
of the child is accomplished ; what is to be done 
with the helpless, screaming, kicking mass of hu- 
manity, covered with a sticky, slimy coating, w T hich 
the attendant is expected to transform into the beau- 
tiful baby, as the creator transforms the unsightly 
chrysalis into the varicoloured butterfly which de- 
lights our eyes? 

I might state right here that it is my opinion that 
from this stage on the infant should pass out of the 
hands of the accoucheur into those of the pediatrist 
who is specially qualified to supervise its further de- 
velopment and its feeding. 

Before this care was taken that a plentiful supply 
of hot water should be on hand, also some cold 
water, which might be needed if the newborn should 
not breathe properly or to bring the temperature of 
the first bath down to the right temperature of 95 
degrees Fahrenheit. Towels and the infant's first 
clothing have been hung around some heating-ap- 
paratus, so that they shall be warm when needed. 

Now comes the first bath. This should be given 
in the well-heated bath-room or in the houses of the 

37 



38 THE CHILD IN HEALTH AND ILLNESS 

less fortunately situated in front of the kitchen- 
range. The temperature of the bath should always 
be measured with the bath-thermometer (see Fig. 3) ; 
it should never be guessed at by the mere immersion 
of the hand or the elbow, because the hand which is 
accustomed to do washing or to wash dishes, or in 
the case of the nurse to apply hot packs or poultices 
is not able to discern minor differences in heat, and 
serious scalding of the baby has not infrequently 
been the result of this carelessness. 

Very important is the w r ay in which the child is 
placed into the bath, for the reason that many a 
child will cry whenever it is given its bath because 
this was done from the very first in such a way as 
to frighten the baby and to make this, w^hich should 
by rights be a pleasurable procedure, one of tor- 
ture. The right hand grasps the child from under- 
neath so that the fingers are in the right armpit and 
the thumb on the right shoulder, the child's back rests 
comfortably on the nurse's hand, its head on her 
forearm, the left hand of the nurse grasps the in- 
fant's feet, and now it is allowed to slide slowly into 
the bath, feet first, until its whole body, with the ex- 
ception of the head (see Fig. 4) is submerged in the 
water. Now the left hand can let go of the feet 
and is free to clean the child (see Fig. 5). The wash- 
ing should be done very gently with absorbent cotton 
and castile soap; if the sticky, cheesy mass covering 
most newborn should be very thick and adherent, it 
should be removed with warm olive oil. Great care 
should be employed in preventing the water of the 



THE CARE OF THE NEWBORN 39 

bath from getting in contact with the face and espe- 
cially the eyes, because the eyes may thus become 
infected after they have escaped this danger during 
birth. 

After the child's body has been thoroughly 
cleaned, it is removed from the bath in the same 
manner in which it has been placed into it, naturally 
in reversed order; it is enveloped in a warm bath- 
towel on the nurse's lap and carefully dried, not by 
rubbing with the towel, but by rubbing gently over 
the towel. Next the face is washed with sterile warm 
water, that is with water that has been boiled, and 
fresh cotton, which is frequently changed. The eye- 
lids should be cleaned first from the outside toward 
the nose with separate pieces of cotton, then the 
rest of the face, and finally the nostrils and ears are 
taken care of with twisted bits of cotton. 

After the bath is completed and the child thor- 
oughly dried the ends of tape with which the cord 
has been tied, and which have been left long for this 
purpose, are grasped and another turn is taken 
around the cord, which has usually shrunken consid- 
erably during the bath, and tied by a firm knot. 

Now the infant is thoroughly inspected for any 
possible malformation and the attention of the phy- 
sician should be called at once to any suspected ab- 
normality. Lastly the disinfecting drops are care- 
fully administered to each eye, preferably by the 
physician, and the infant is now ready to be dressed. 

The first part of the dressing consists in the care 
of the stump of the cord. This is best done by 



4 o THE CHILD IN HEALTH AND ILLNESS 

wrapping it in several layers of sterile absorbent 
gauze, and it is thus placed upwards against the ab- 
domen. It is entirely immaterial if this is done a 
little more to the right or to the left side, though 
old-fashioned notions, of which we meet so many 
when taking care of children, seem to favour the left 
side of the body; in this position it is held and pro- 
tected by a flannel band, three inches in width and 
about eighteen inches long, which is snugly fas- 
tened around the abdomen with safety-pins (see 
Fig. 6). 

The clothes of the newborn are the same that it 
will wear during the first months of life and will be 
described later. 

The bathing and dressing of the newborn should 
be done as expeditiously as possible, and any chilling 
during these procedures should be most carefully 
guarded against. Everything should be ready be- 
fore the nurse begins, and all articles that come in 
contact w T ith the child's skin should be well warmed. 
The door of the room in which it is to be done should 
be locked, in order to prevent anybody from enter- 
ing the room during this time and thus creating a 
draft of cold air. The temperature of the room 
should not be less than 68 degrees Fahrenheit nor 
much above this. The attendant will also do well to 
tie a clean bath-towel around herself in form of an 
apron to protect her own clothing. 

After the baby has been dressed it should be 
placed in its crib and allowed to sleep. 




Figure 3. bath-thermometer. 





Figure 6. newborn with cord 
wrapped in gauze and bind- 
er about to be applied. 



V 



V, 




Figure 4. newborn being put 

INTO BATH. 




y 



Figure 5. newborn being held in 

BATH. 



■■MHHBMM 



THE CARE OF THE NEWBORN 41 

When should the newborn be put to the breast and 
how often should it be allowed to nurse? 

Immediately after birth both the mother and the 
newborn are exhausted, the one by its passive la- 
bours and the truly tremendous strain of suddenly 
accustoming itself to entirely changed surroundings 
and by having to learn, of a sudden, to do for itself 
things that, so far, have been done for it by the or- 
ganism of its mother ; the other by her active labours. 
What they require is a good long twenty-four hours' 
rest. The baby does not need any food at this time, 
nor could it get any at the breast, beyond a few 
drops of what is called colostrum, which will give 
it the gripes at that. It comes into the world 
well nourished and it has enough to do to adapt 
itself to its new surroundings, to the change in 
its circulation and the unaccustomed act of breath- 
ing, without our subjecting it to any further loss 
of strength from repeated and purposeless nursing, 
which tires it and the poor mother, and, besides, 
may get it so disgusted with its fruitless efforts, 
that it, showing more sense than we do, will soon 
refuse the breast altogether. This was a frequent 
cause of our having had so much trouble in making 
babies take the breast and why we have been unable 
in many cases to make them nurse at all, even after 
the milk-supply had become plentiful. 

On the second day, after both the mother and her 
infant have had a good rest, we let the baby take 
the breast once or twice, so that it can now obtain 
some of the colostrum, which by this time will be 



42 THE CHILD IN HEALTH AND ILLNESS 

present in larger quantities in the breasts. This 
will clean its bowels of the first black stools, the 
meconium, and do this- better than any of the old- 
fashioned teas — saffron tea, for instance, which is 
given because it is yellow and is therefore supposed 
to be good for the normal jaundice. If the baby 
cries much we give it as much warm water as it 
wants, but without any sugar. 

On the third day we allow the baby to nurse three 
times; four times on the fourth day; and from the 
fifth day on we allow it to nurse every four hours 
in daytime but never at night. This gives it five 
feedings daily, usually and best at 6 and 10 A. M. 
and at 2, 6 and 10 P. M. If it sleeps it is awakened, 
and it is surprising to see how soon the little ones 
get accustomed to this regime, and how well they 
will soon know w T hen it is time for nursing. 

This method, which is the one now in great favour 
among European pediatricians, is meeting with fa- 
vour over here among physicians, nurses and, last 
but not least, mothers, because it proves to be almost 
universally successful, and its growing popularity 
is well deserved. 

It is only necessary to observe the condition of 
the mothers when they have had a full night's 
rest every night from the time the baby was born ; 
how well they look and how they have a plentiful 
supply of good milk. The writer allows the nursing 
mothers under his care to eat anything they want, 
after they have had their first refreshing sleep after 
childbirth ; he no longer places any restrictions upon 



■■■ 



THE CARE OF THE NEWBORN 43 

their diet, as long as they are getting sufficient nour- 
ishment to keep in good health. It is also only neces- 
sary to observe the good condition of the babies ; how 
quietly they sleep, and the look of contentment upon 
their little faces ; this in itself will be sufficient proof 
to mothers of the advantages of this method in al- 
most all cases. 

The infant is called a newborn as long as the navel 
is not healed, that is during the first two weeks. 
During this time the navel demands a great deal of 
care, but in so far only as we have to guard against 
its becoming infected. This can easily be prevented 
by following the laws of antisepsis and asepsis. 

The nurse should remember that the discharge 
from the mother always contains pus-producing bac- 
teria in large numbers, which, though they are not 
dangerous to the mother, may easily be transferred 
by the nurse 's hands to the navel or the skin of the 
newborn, there to cause infections which can not be 
explained in any other way. Or they may be trans- 
ferred by means of the child's bath-tub, which should 
be reserved for the exclusive use of the infant, but 
which is used sometimes as a receptacle for the 
soiled linen from the mother's bed. Nor should we 
forget the water used for the baby's bath, and in lo- 
calities in which the water-supply is not above re- 
proach only water that has been boiled should be 
used for this purpose. 

Whenever the people can afford this, two nurses 
should be engaged; one takes care of the mother 
only, the other to be in charge of the infant. Where 



44 THE CHILD IN HEALTH AND ILLNESS 

this is impossible, for obvious reasons, the nurse 
should give the baby its bath with disinfected hands 
in the morning before she changes the mother's 
clothing, and she should use rubber gloves for this 
latter duty. Quite naturally the baby's bath-tub 
should never be used for anything but the baby. 

There seems to be still some difference of opinion 
if the newborn should be bathed every morning or 
not. As long as the necessary precautions are taken 
and especially if sterile water be used this is cer- 
tainly advisable. The short period during which the 
child stays in the water will not interfere with the 
drying out of the cord, and in the bath the gauze- 
dressing can be soaked and carefully removed and 
then be replaced by fresh dressings. After the cord 
has dropped off the clean water can only be bene- 
ficial to the healing wound, wdiich is afterwards 
carefully dried w T ith absorbent cotton and slightly 
dusted with some mild antiseptic powder and 
dressed with clean gauze. 

One of the most objectionable practices is the 
routine wiping out of the mouth of the newborn. 
This unnecessary torture of the little ones corre- 
sponds to the toilet of our own mouths with a stiff 
wire brush/ Since discarding this obsolete practice 
the writer has seen but very few cases of in- 
fected mouths. 



CHAPTER IV 
THE CARE OF THE INFANT 

BATHING. Nothing is so important for the care 
of the skin of the infant as the daily morning 
tub-bath, and no amount of washing will equal it in 
cleansing every little fold on the surface of the body. 

The bath is best given before the second feeding, 
about 9.30 A. M., and should be administered in the 
way described for the newborn. The greatest care 
must be taken to prevent chilling of the infant dur- 
ing its bath, and it is therefore always best to give it 
in front of a special heater, gas or electric, or near 
the kitchen-range, and a screen should be placed be- 
tween the bath-tub and the door, though it is prefer- 
able to lock the door of the room to prevent any rush 
of cold air. 

The temperature of the water should be 95 degrees 
Fahrenheit for the first six months, then 93 degrees 
Fahrenheit ; the temperature of the bath should al- 
ways be determined with the bath-thermometer aft- 
er the water has been stirred well. 

The baby should not be allowed to stay in the bath 
longer than from three to five minutes. If it is al- 
lowed to stay longer in the warm water we will ob- 
serve that its skin and muscles become flabby ; it will 

45 



46 THE CHILD IN HEALTH AND ILLNESS 

no longer kick lustily in the water or while it is 
being dried, and owing to the dilatation of the blood- 
vessels in its skin it will perspire for some length of 
time after the bath. 

Cold showers at the end of the bath are not advis- 
able for infants except in certain conditions, when 
they may be the means of saving a baby's life; then, 
however, they should be ordered by the physician for 
some definite time, but as a routine procedure they 
should not be used. 

Great care should be taken that the deep folds of 
the skin, especially in the groins, the armpits, around 
the neck and behind the ears, are carefully cleaned in 
every bath. The face must never be washed in the 
bath, but this must be done with clean water after 
the infant's body has been dried. 

During the bath the infant's body must be care- 
fully examined every time for any possible abnor- 
mality or injury. 

The soap used for infants must be mild and non- 
irritating; the best is a good castile soap, not some 
scented soap with some high-sounding name, nor 
some medicated soap, which is usually irritating to 
the tender skin and the price of which is excessive 
because the consumer has to pay for the advertis- 
ing. 

The best and surest sign that the attendant is giv- 
ing the bath in the right manner is this, that the 
baby shows its pleasure at the procedure by lustily 
kicking around and hitting the water with its little 
hands ; whenever we see a healthy infant which cries 




I *, wmmm I ■■■■ ■■ 



d M 



Figure 8. — New method of putting on diaper 




i 






Figure 7.— Old fashioned way of putting on diaper 





Figure 9. pad over diaper 



THE CARE OF THE INFANT 47 

luring the bath, then we can make up our minds 
that it is not skilfully given or that the baby does 
lot feel secure in the nurse's hands because it has 
3een frightened at some time or other by being 
laced into the water too suddenly. 

The drying of the infant's body after the bath 
should be done very thoroughly but gently, by rub- 
bing with the hand over the bath-towel w T hich the 
nurse has fastened over her apron before giving the 
Dath. 

After the face has been washed the eyes, especially 
he inner corners, are washed with clean pieces of 
absorbent cotton, one for each eye ; the nostrils and 
ears are cleaned with twisted bits of cotton, and 
finally the yellow scales and crusts which we find 
so frequently on the scalps of infants are softened 
with w T arm sweet-oil and then gently removed; 
sweet almond-oil is better, as it does not become 
rancid, though it is a little more expensive. 

The bathing completed, the baby is wrapped in a 

? resh warm bath-towel and placed in its crib for 

fifteen to twenty minutes before it is dressed; the 

reason for this is the fact that all babies perspire 

;his length of time even after a well-given bath, and 

;his perspiration would otherwise be taken up into 

the fresh clothing and might then irritate the tender 

skin. The nails of the fingers and toes should also 

be looked after at the time of bathing and should be 

trimmed at frequent intervals. In hot weather the 

infant may be given a sponge several times during 

the day. It is also washed over the respective parts 



48 THE CHILD IN HEALTH AND ILLNESS 

whenever it has soiled itself with its stool. Before 
the evening nursing, at six o'clock, it is also daily 
given a sponge before its clothing is changed for the 
night. 

Cleaning of the Mouth. As stated above, the ba- 
by's mouth should never be cleaned until after the 
teeth have appeared and then these only demand at- 
tention. Sore mouth or thrush, a fungus growing in 
the mouth, is usually due to either digestive troubles 
or to the injury of the lining of the mouth by rub- 
bing in the superfluous attempts at cleaning the 
mouth, or by injuries with sharp-edged articles 
which the older baby has put into its mouth. The 
rubber nipple or pacifier, which has a habit of drop- 
ping on the floor and which is then, in only too 
many cases, picked up to be given back to the baby 
after wiping it hurriedly on an apron, and which is 
for this reason usually teeming with bacteria, is 
also a very frequent source of infection of the 
mouth of the infant, aside from its being entirely un- 
necessary. The healthy and well-taken-care-of baby 
cries but very little, and why this crying, which is 
usually for good cause, should be choked off by ar- 
tificial means is beyond the writer's understanding. 
In infants who are sick or whose digestion is dis- 
turbed it is without the least doubt better to re- 
move the cause for the persistent crying than to 
fool the baby and ourselves by removing the ef- 
fect instead of the cause. 

The pacifier is a sign of deficient care or poor 






-- 



Figure 10. baby clothes 



THE CARE OF THE INFANT 49 

feeding of the infant and is a reproach to those who 
are responsible for its use. 

Since the writer has interdicted the cleansing of 
the baby's mouth and has prohibited the use of the 
pacifier he has seen only very few cases of sore 
mouth or thrush, nor has he observed anywhere 
near the number of swollen glands under the jaws. 

Putting the Infant Dry and Powdering. The in- 
fant should be given clean diapers every time it has 
wet or soiled itself. Urine is generally passed dur- 
ing or right after a feeding and once or twice in 
between and several times during the night. Infants 
who spit up some of their food very readily when 
disturbed are best changed immediately before 
nursing and then again some time after it ; otherwise 
it is naturally best to change them, without too much 
shaking of the baby, immediately after nursing be- 
fore they are placed back in their crib. When the 
infant gets restless during its sleep and cries, this 
is usually a sign that it wants to be and should be 
changed; the healthy baby, especially when at the 
breast, will go to sleep again right away. 

Should the child's buttocks be sore, then it must 
be changed at once whenever it has wet itself and 
the attendant should frequently ascertain if this is 
the case. 

Girls must always be cleaned from the genitals 
backwards toward the anus ; otherwise the bacteria 
from the stools may be carried into the urethra, 
whence they may ascend to the bladder, to cause 



50 THE CHILD IN HEALTH AND ILLNESS 

here an inflammation, an ailment which is by no 
means rare in babies, especially baby-girls. 

Powdering the baby whenever it is changed is not 
at all necessary, especially in the private house when 
it is looked after by an experienced woman or the 
careful mother, but in hospitals and also in very fat 
infants it is preferable to use some simple powder 
such as talcum — not the medicated or scented kind 
which is much advertised — or stearate of zinc, which 
is to be recommended w 7 hen the baby is sore. Bolus 
alba, or sculpter's clay, is at the same time the cheap- 
est and best when it is sterilised by baking in the 
hot oven for one hour and then powdered finely. 

One of these powders is applied with a box over 
w r hich a piece of gauze has been tied, then the super- 
fluous powder is removed with a clean piece of ab- 
sorbent cotton, principally from the deep folds 
around the legs and buttocks ; otherwise the powder 
may form an irritating paste with the urine, espe- 
cially when these folds are not carefully cleaned 
every time the baby is changed, and the physician 
will be told by the mother or nurse that "the baby 
is sore, though I powdered it very freely every 
time. ' f 

The Clothing. The clothing of the baby should 
be chosen according to the thermometer but not ac- 
cording to the calendar, and it may be necessary, in 
the climate of Western New York at least, to change 
it several times a day. It should also be as simple 
as possible, without any expensive laces, which are 
hard to wash and difficult to put on. A rosy face in 





FIGURE 11. BABY CLOTHES WITHOUT 
PINS OR BUTTONS, AND SHAPED DIAPER 



Figure 12. sleeping ba< 




Figure 13. night gown 



THE CARE OF THE INFANT 51 

a simple little cotton slip, provided this is clean, is 
far preferable to a peaked little face, the paleness of 
which is enhanced by a frame of expensive Brussels 
lace. The clothing should also be such as to allow 
the infant to kick and to exercise its limbs. 

The most frequent mistake in clothing babies is 
that the clothing is as a general rule too heavy, so 
that the poor little ones are in a continuous Turkish 
bath. This is what makes them so often pale and 
flabby ; the increased loss of water from perspiring 
prevents their gaining in weight and they are easily 
chilled. On the other hand a frequent mistake is 
also made by having the babies insufficiently clothed 
when they are taken out for an airing; this is due 
in many cases to vanity, and the little ones have to 
suffer for this. 

It is a very difficult matter to explain in writing 
how the clothing should be put on ; this is a matter 
of experience and can only be learned by practice. 
Only a few words therefore about the principal arti- 
cles of clothing. 

The napkin should be made of some soft material ; 
bird's-eye cotton is perhaps the cheapest and best. 
They must be put on snugly and smoothly so that 
they will not press nor rub on the skin anywhere. 
Flannel or woollen diapers are bad because they are 
hard to wash and they prevent evaporation; after 
they have been used a few times they will frequently 
smell stuffy and ammoniacal. The size of the diaper 
should be one square yard for normal-sized children. 
The old-fashioned way to put on the diaper and the 



52 THE CHILD IN HEALTH AND ILLNESS 

one mostly in use is to fold the diaper twice into 
triangular shape, then lay it down with the longest 
side of the triangle at the top, place the child on 
this so that this comes in the middle of the back, 
draw up the point of the diaper between the legs, 
fold the two free ends over the lower abdomen and 
pin it with safety-pins (see Fig. 7). In every big 
dry-goods store we can find now patterns for a 
diaper which is shaped in the back and which is 
provided with tapes instead of the safety-pins ; this 
is much better because it fits more snugly and is 
easier to put on (see Fig. 11). The new and best 
way to put on a diaper, one which the writer 
has occasionally seen employed by mothers from 
different parts of this country and which has also 
been described by a Southern physician, is to fold 
the diaper into rectangular shape, instead of the 
triangular and to pin it over the sides on each hip, 
in the way in which women wear their monthly band- 
ages (see Fig. 8); this has the advantage of pre- 
venting the bunching of a considerable part of the 
diaper between the legs and thus forcing these apart, 
and will also prevent pressure on the lower part of 
the abdomen and its contents. A smaller diaper 
or pad of some absorbent material should come out- 
side of the first one (see Fig. 9). 

Naturally only newly washed and boiled napkins 
should be used, and we must never permit them to 
be simply dried and then used again. The best and 
simplest way, especially in institutions and in the 
sometimes cramped quarters of the modern apart- 



THE CARE OF THE INFANT 53 

ment house, is to tear off the desired length from a 
bolt of bird's-eye cotton which has been sterilised by 
dry heat and to throw it away after it has been used 
once ; the writer has observed this in the service of 
some of the New York hospitals and was very much 
impressed by it. Eubber diapers or drawers can- 
not be condemned too severely ; they are a frequent 
cause of irritation of the skin because they make a 
poultice of ammonia of the wet diaper. 

The shirt should be of cotton and must be pinned 
to the diaper (see Fig. 10) ; those with tapes are 
preferable to the ones which are fastened with pins 
or buttons (see Fig. 11). 

Cotton stockings must be worn except during the 
hot summer months and must also be fastened to 
the diaper, either with tapes or with safety-pins. 

Shoes are not needed until the child is in short 
clothes and then they should be knitted ones. 
Leather shoes should not be worn until the child 
learns to walk. 

Over the shirt comes a pinning blanket which is 
long enough to be folded over the feet to keep these 
warm; then a dress and in cool weather a knitted 
jacket. 

The flannel belly-band or binder should be done 
away with altogether ; it is really put on to prevent 
a rupture at the navel; this it never does. It is 
rather difficult to pin it on snugly and at the same 
time smoothly without wrinkles, and when the child 
is otherwise clothed right it is entirely superfluous. 

When the baby is about five months old and its 



54 THE CHILD IN HEALTH AND ILLNESS 

back is strong enough to support it, the clothes may 
be shortened to three-quarter length, that is to the 
feet. At seven months, when it begins to crawl, it is 
put in short clothes and it is now advisable to re- 
place the outer diaper or pad by a pair of buttoned 
drawers, which are pinned to the shirt. 

During the hot summer months the baby should 
be dressed as lightly as possible. The writer has of- 
ten told mothers that all the child should wear then 
is : a gauze shirt, a diaper and a smile, the first two 
being all that is necessary for the infant's comfort 
and the last one coming by itself as a natural con- 
sequence. 

At least once a day the baby should be placed on 
a hard mattress, without any clothing, naturally in 
a well-heated room, and should be allowed to stretch 
out its body and to kick to its heart's content for at 
least fifteen minutes; no more happy time for the 
little one can be imagined than when it finds out 
that it has feet and toes to play with. 

When they are to be taken out for an airing young 
babies should be wrapped up in a woollen blanket 
or a sleeping bag (see Fig. 12) which leave only the 
face free; older ones are put in a coat of varying 
weight, according to the outside temperature and 
their head covered with a knitted cap; a veil is an 
unnecessary torture. In weather which is so in- 
clement that the baby's face would have to be pro- 
tected, the infant can get its airing in a room, the 
windows of which are opened, dressed the same as 



THE CARE OF THE INFANT 55 

for outdoors. Otherwise the cap should never be 
worn indoors. 

At night the baby should wear a fresh shirt, dia- 
pers and a long flannel night-gown with a draw- 
string through the bottom, which is to be tightened 
so that its little feet are never exposed to the cold 
air (see Fig. 13). 

One of the hardest things to teach mothers and 
nurses is this, that the baby's head and face should 
not be protected all the time by a cloth or shawl, and 
that daylight does not hurt the infant's eyes as 
long as it is not exposed to the direct bright rays 
of the sun. 

The Bed. The simplest and cheapest kind of a 
bed is a long clothes-basket the inside of which is 
covered with a removable lining of light-coloured 
cotton cloth ; a woollen blanket folded so as to fit the 
basket serves as a mattress (see Fig. 14). There 
should be two blankets, so that one can be aired on 
the washline while the other one is in use. The best 
bed for infants is one of the white enamelled iron 
hospital-beds (see Fig. 15). These are lined with a 
light-coloured washable cloth which can be buttoned 
on and can easily be changed when soiled; this 
serves as a protection against chilling when the door 
is opened. The mattress in these beds is made in two 
or preferably three pieces; it is stuffed quite hard 
with horse-hair ; this is protected by a piece of rub- 
ber cloth over which comes the sheet; this latter is 
best pinned down at the corners to prevent its be- 
coming wrinkled ; over this comes a so-called draw- 



56 THE CHILD IN HEALTH AND ILLNESS 

sheet under the buttocks of the child, which can be 
readily changed. A pillow for the head is unneces- 
sary especially for young infants ; for older ones a 
thin hard pillow of horse-hair may be used. For 
children suffering from rickets, whose skull is fre- 
quently very soft, a ring stuffed tightly with lamb's 
wool should be used instead of the pillow, to pre- 
vent deformities of the head; this ring should be 
changed at frequent intervals because these children 
perspire very freely on the head. 

Needless to say that an infant should not be per- 
mitted to be lying too long in the same position, be- 
cause this also might lead to deformities of the head, 
and that it should not be placed on its left side until 
about two hours after feeding. 

The baby should be covered with a woollen blanket 
which must be folded into a sheet to prevent its 
being soiled; at the upper corners of this should 
be sewed tapes which can be tied to the bed, so that 
the child can not uncover itself during the night. 

In summer the baby's bed should be covered with 
a piece of netting to protect it against flies and mos- 
quitoes, but this must be far enough away from the 
child so that it can not pull it down and to permit 
free access of air. 

What shall we say about the cradle in which the 
child can be rocked to sleep? This is common 
amongst most of the people on the face of this globe, 
civilised as well as uncivilised; exceedingly small is 
the number of those nations where it is unknown. 
Does it really make the infants nervous or does it 





Figure 16. hammock 



Figure 17. wuxow baby-buggy 





Figure 18. high chair 



Figure 19. walking pen 



THE CARE OF THE INFANT 57 

not? The most we can say against it is that it is 
unnecessary and that nowadays infants get along 
without it. 

For sleeping outdoors in summer the baby may 
be placed into a hammock which is covered with mos- 
quito netting; this is most conveniently fastened to 
a special support so that it can be moved around 
into the shade (see Fig. 16). 

The Baggy. The best buggy to bring the baby 
out into the street in is still the old-fashioned wil- 
low affair. It is roomy and the inside of it should be 
covered with a removable washable cloth lining; it 
is furnished with a half -top which can be changed 
according to the direction of the wind and sun, with 
stiff springs, rubber tires and a brake to be set when 
the buggy is standing (see Fig. 17). The measures 
of the basket should be as follows : Length 36 inches, 
depth 14 inches, width 18 inches. The willow should 
have a sufficiently wide mesh to permit of free venti- 
lation. Leather or oil-cloth lining should not be 
allowed because it interferes with the ventilation. 

The new English or Princess buggy, though it 
looks very smart with its narrow, straight, but 
highly varnished body, which is lined with smelly 
leather and like material for the top, its loose 
springs, which are in constant motion, its leather 
curtains, which can be tightly fastened so as to ex- 
clude even the last vestige of fresh air of which the 
child is so much in need in winter as well as in sum- 
mer, should never be allowed. Any thinking mother 
or nurse will easily see its disadvantages, and they 



58 THE CHILD IN HEALTH AND ILLNESS 

need only have a smell of them, after they have 
been in use for some time, to be convinced. Another 
objection to these is that they are not large enough 
for the child's comfort. 

The Room. The room of the baby should be large 
and airy with an exposure to the South, South- West 
or South-East. The windows, at least tw r o, should be 
large and easily opened ; in summer they should be 
protected by fly-screens ; shades should be provided. 
A corner-room is the best to ensure good ventilation, 
and the room should, whenever this is possible, be 
located at the rear of the house to keep out the 
noises and the dust from the street. Everything in 
the baby's room should be light in colour and wash- 
able ; heavy portieres and carpets serve only to col- 
lect dust; window-curtains should be of cretonne and 
easily removable for washing. 

The floor should be either of hard-wood or covered 
with linoleum; matting is not advisable because it 
is too much of a dust-collector. The temperature of 
the room should always, day and night, be around 
68 degrees Fahrenheit. 

The bed should be so placed that it is protected 
against direct air-currents when the doors and win- 
dows are opened (see Fig. 20). For young infants 
it is advisable to have a screen covered with some 
washable material around the bed ; this can also be 
used to protect the bath-tub at bathing time. 

Modern technic and the art of interior decorating 
have produced some effects for the baby's room 
which are very pleasing to the eye and at the same 



WINDOW 




DOOR 



Figure 20. nursery 




Figure 21. baby cariole 



THE CARE OF THE INFANT 59 

time most serviceable ; the expense of these is by no 
means prohibitive. 

Electric fans should be used as little as possible ; 
they should never be allowed to play directly over 
the infant's face, though they are a splendid means 
of giving relief from the oppressive moist heat of 
the summer in our climate. The electric fan does 
not however take the place of ventilation of the air 
in the room; this must always be done by opening 
the windows several times a day, during which time 
the child should either be taken out or into another 
room. 

Perfumes or other artificial means will never make 
up for insufficient ventilation. 

Strong-smelling flowers should never be permitted 
in the room. 

The furniture for the baby's room should be with- 
out any sharp edges, simple and easily cleaned, light 
wooden pieces painted with light enamel are prefer- 
able. 

Beside the iron bed the room should contain a 
chair or two for the attendant; a low chair with a 
foot-stool to be used by the mother when she is 
nursing the infant; a stand on which the baby's 
clothing can be warmed; a bath-tub best of enamel 
ware, on a stand high enough to make bathing com- 
fortable ; a small wash-basin for the face and eyes ; 
a basket stand with the powder-box, soap-tray, etc. ; 
a chest-of -drawers for the clothing ; an iron enamel 
pail with a cover for the soiled diapers; a narrow 
high table with a pillow which is covered with oil- 



60 THE CHILD IN HEALTH AND ILLNESS 

cloth on which the baby can be dressed and changed. 

When the infant is old enough to sit up alone it 
should have a high chair in which it can be propped 
up and securely fastened and in which it can play 
(see Fig. 18), but the child should never be taught 
to sit up ; it knows well enough when its little back 
is strong enough to hold it. This chair should not 
be provided with an opening for the chamber, be- 
cause this, when used injudiciously, may cause the 
rectum to protrude. Nor should babies be permitted 
to sit up too long at a time. 

When the baby is old enough and strong enough 
to sit up it should be taught the use of the chamber, 
at least for the movements of its bowels, and if this 
is done regularly every morning and evening at the 
same time we will be astonished to see how easy it 
is to train even young children and to get them ac- 
customed to regularity, and the physician will then 
no longer hear the frequent complaints about con- 
stipation in children. The writer knows of at least 
one nurse who propped up very young infants 
in a well-padded little chair and who succeeded quite 
universally in teaching her little charges the use of 
the chamber by the time they were about six weeks 
old. 

As soon as the baby shows an inclination to crawl 
around it should be provided with a walking-pen 
or baby-yard (see Fig. 19), in w T hich a clean blanket 
is placed; this is kept for this purpose to prevent 
infection from the dust of the floor. These pens can 
be bought, but any one handy with a few carpenter's 



THE CARE OF THE INFANT 61 

tools can easily make one at home at very little ex- 
pense. Verv good are also the baby-carioles (see 
Fig. 21). 

When choosing the baby's toys we must always 
remember that it will place everything into its 
mouth, consequently things with sharp edges, which 
lose colour, or woolly things must be avoided. The 
best toys for infants are rubber dolls, but only 
those without the little whistle which comes out so 
easily and may be swallowed or aspirated and thus 
endanger the infant's life; these rubber play-things 
have also the great advantage that they can be kept 
clean by washing. 

The Education of the Infant. The physician will 
frequently be asked by the fond but inexperienced 
mother if it is possible to educate a baby. This 
can certainly be done and should be done from the 
very first day of its life. That it is not always done 
is equally true; the more the pity. 

What else is it but education if we teach the infant 
regularity in its meals from the very first? What 
else when the baby is put to bed after nursing and 
goes to sleep regardless of the light or anybody 
talking or walking around? 

Look, on the other hand, at the spoiled little tyrant 
who will go to sleep only in a darkened room when 
everything and everybody is absolutely quiet, and 
at that only in the mother's or nurse's arm, who has 
to be rocked to sleep and perhaps with a pacifier in 
his mouth. All these things are simply a matter of 
education. Let the baby understand from the very 



62 THE CHILD IN HEALTH AND ILLNESS 

first that it will not be taken up every time it cries 
a little, that it does not require something in its 
mouth to go to sleep with, and we will not see so 
many "nervous" babies. 

The yonng baby should be left entirely by itself; it 
should not be played with; it should realise that its 
whole duty in life, for the present at least, is to 
drink, to sleep and to grow. This they will soon 
learn to do and they will then show by their looks 
and by their weight-chart the result of a sensible 
bringing up. 

Naturally when a baby has been ill or when it has 
once been spoiled this is not so easy. It w r ould be a 
grave mistake for a doctor or a nurse to begin to 
educate an infant when it is in poor health, but 
when they are called in early they can do a great 
deal of good in this way, and if this became more 
universal we would not see so many babies who cry 
at the least pretext or even without any, who have 
to have a pacifier in their mouths all the time, and 
who have to be rocked or held continuously. 

In the fourth or fifth month, perhaps even earlier, 
we can begin to train the infant to keep itself clean. 
It will soon learn that it will be relieved of the un- 
comfortable position on the chamber as soon as it 
has done its duty. Some children learn this very 
quickly while others are much harder to teach ; this 
has nothing to do with their mental brightness but 
it is simply a matter of individuality. 

With older infants wo can start to make them 
mind comparatively easily if we preserve a quiet but 



% 



c 



s ,*. 










.. % 



I 



Figure 22. how to carry young 

INFANT 










c> 



\ 






Ftgure 23. how to carry older 

INFANT 



THE CARE OF THE INFANT 63 

firm demeanour towards them and teach them that 
angry crying or spells of temper will not succeed 
in getting for them what they want. Roughness or 
corporal punishment, or shouting at a baby, must be 
strictly interdicted ; it will so frighten them that they 
may show the consequences for the rest of their lives. 
Make a baby understand that it can not have its own 
will all the time and that it is just as easy, and pleas- 
anter at that, for it to mind and we will usually 
succeed. 

It is also advisable to let a baby have only one toy 
at a time and we will then be spared the far too fre- 
quent sight of the baby of the wealthy which sits 
in the midst of the most wonderful playthings and 
who is still bawling for the moon, while its less for- 
tunate brother is contented with a rag doll which 
has lost all semblance of what it had been. 

Babies should be left alone as much as possible; 
they should not be taken up from a sound sleep to 
be shown to an admiring circle of relatives and 
friends, nor should they be taught those "cute" lit- 
tle tricks in which young mothers delight, especially 
with their first-born. This premature development 
of the brain is not beneficial; it makes babies old- 
fashioned and precocious ; the result of this will fre- 
quently be seen later in life. Older infants should 
also be left to their own resources as much as pos- 
sible, as they will then be most contented, nor should 
they be reproved for the least little thing without 
any cause, at least as far as they can see. 

A young baby may be carried around a little at a 



64 THE CHILD IN HEALTH AND ILLNESS 

time with its head and back well protected, so that 
the forearm near the elbow supports the head, the 
same hand under the buttocks and the other hand 
supporting the feet (see Fig. 22). The arms should 
be changed regularly to prevent curvature of the 
spine. 

When the infant can sit up it may also be carried 
around on the arm with the other hand supporting 
its back (see Fig. 23), but again we must not for- 
get to change it from one arm to the other so as to 
make it use both hands equally well. 

Babies should never be taught how to walk. When 
they feel that their legs are strong enough to carry 
their weight, they will try it themselves, grasping 
the mother's skirt or a chair, or better still, in their 
little pen. If taught too early to stand up and walk 
their legs may become crooked. Walking-chairs and 
baby-tenders are not good. If the baby does not 
show T ajiy inclination to walk after the completion 
of its first year the physician should be consulted, 
though some perfectly healthy babies may be very 
backward in learning how to do this. 

Never pull up a baby by its arms; always sup- 
port its head and back with your hand. Xor must 
an infant which is learning how to walk be held by 
one hand only. Numerous are the cases in which this 
has caused a fracture of the collar bone or a disloca- 
tion of the shoulder, or what is even more serious, 
injuries to the nerves of the arm. 



CHAPTER V 
THE FEEDING OF INFANTS 

BREAST-FEEDING 

TT^VERY healthy mother must nurse her baby at 
JlL/ her own breasts until such time when it is suf- 
ficiently developed for other food. 

This is the one immutable law of nature ; thus only 
can the mother assure her beloved one of life and 
health; thus only can she preserve her own health 
and happiness. 

Breast-feeding represents for the young child the 
transition from the entirely dependent mode of feed- 
ing in the mother's womb to the independent feeding 
of the older child. 

Mother's milk coming from the human body is in 
quantity as well as quality and in the proportion of 
its different components specially adapted to the 
needs of the human young. No other kind of food 
can take its place. It is relatively free from germs 
and is always provided at the right temperature. 
It alone deserves the name of a natural food for this 
stage of life. 

Every other food, no matter what its composition, 
is unnatural. It will demand from the infant labours 
during its digestion which are by no means normal. 

6s 



66 THE CHILD IN HEALTH AND ILLNESS 

We know from experience that infants who have 
been fed naturally have a much better chance to 
live through the first period of life and that they 
succumb only rarely to disturbances of digestion 
and nutrition. 

Unfortunately we still find a much larger number 
of children fed unnaturally than is necessary, a most 
regrettable condition which frightfully increases the 
mortality among children during the first year of 
life. 

Now what are the causes for this? 

Is it viciousness or ignorance, or is it the result 
of a failure of the breasts to develop? 

Certainly not the latter, if we stop to consider 
that only a hundred years ago or less nearly every 
woman successfully nursed her offspring. 

We will not consider the so-called upper classes — 
a fine distinction, by the way, in this democratic 
country of ours — who closely approach in their mode 
of life the days of degenerate Rome ; not the Rome 
of the republic, but of the last two or three cen- 
turies of the empire, when love of pleasure and ease 
drowned all sense of duty ; when women had no time 
for their children and when they thought they had 
done more than their duty when they had carried a 
child and given birth to it and left its bringing up 
entirely in the hands of menials. This was one of 
the principal reasons for the downfall of this same 
mighty empire. Are we in this great land of ours 
getting ready for the same dry-rot and decay? 

Any one who will take the trouble of investigating 



THE FEEDING OF INFANTS 67 

this subject will find that at least ninety out of one 
hundred of all mothers are able to nurse their off- 
spring; in some hospitals even ninety-five succeed 
in fulfilling this their noblest duty. Why then, may 
we well ask, can it be possible that at the present 
time and in this country of ours not more than forty 
or at most forty-five out of every one hundred 
women nurse their own babies ? 

The explanation for this appalling condition can 
be readily found. Physicians as a rule are not do- 
ing their full duty in this respect; they have also 
been too credulous in accepting some flimsy excuse, 
brought forward by the grandmother or nurse or 
some other person, why the young mother could not 
nurse her child, though they knew full well that this 
was nothing but thinly veiled unwillingness of per- 
forming a most important duty. 

Still the great majority of mothers are not vi- 
cious but only thoughtless and ignorant of the true 
conditions. They do not realise of what they de- 
prive their little ones in denying them the only 
food ever intended to be placed into a baby's mouth, 
the milk of its own mother. They are misguided 
by what they read in the daily papers and in their 
magazines about the many ways in which they can 
change cow's milk to be the equal or even better 
than the product of their own breasts. They 
read little books, written by reputable medical 
men at that, which give all kinds of more or less 
complicated formulae. And, last but not least, they 
receive by almost every mail, after the birth of the 



68 THE CHILD IN HEALTH AND ILLNESS 

baby has been filed with the registrar of vital statis- 
tics, booklets sent out by the manufacturers of pro- 
prietary baby-foods. 

Can this condition be changed? 

Is it possible to educate the woman of to-day? 

Can we make her realise which way her duty 
points? 

We most assuredly can and we are doing so daily. 

All the physician has to do is to take the time and 
trouble, small as it is in comparison to the end in 
view, to explain matters to the mother and to show 
her the conditions in their true light. 

Women of to-day are better educated and more 
enlightened than they ever w r ere before and they 
are therefore more open to sound reasoning and to 
honest conviction, especially when it is brought for- 
ward with the proper amount of healthy enthusiasm 
instead of in a half-hearted way. 

When engaged to attend a pregnant woman in her 
imminent confinement it is the duty of both the phy- 
sician and the nurse to talk these things over with the 
expectant mother. But not enough with this, they 
must make this duty easier for her when the time of 
its fulfilment comes. 

The time to begin the education of the woman for 
the task of nursing her future generation begins 
with the growing girl. She must be preserved from 
wearing ill-fitting corsets which press upon the nip- 
ples and stunt the natural growth of the breasts. If 
the mother should notice that the nipples of her 
young daughter are drawn in or if the ever-attentive 



THE FEEDING OF INFANTS 69 

physician should call her attention to this faulty 
condition, then she can easily teach the young girl 
how to remedy this by simple manipulations and by 
drawing out the nipples gently every morning and 
evening, and this can be done in such a tactful way 
that the attention of the girl is in no way drawn to 
her reproductive organs nor will she be able to guess 
at the purpose for which this is advised. 

Where this has been neglected at the proper time 
a great deal can be done still, if the prospective 
mother is instructed early enough to draw out her 
nipples in order to make these the proper size for 
the baby to take hold of. 

She should also be taught to wash her nipples 
morning and evening with cold water and to give 
them a gentle massage at the same time, so as to 
harden the skin and to prevent its cracking later; 
this may be the means of saving her a great deal of 
pain and discomfort in the future. 

In order to insure for both the mother and the in- 
fant the greatest comfort and the best result during 
the act of nursing, a great deal depends upon the 
teaching of young and inexperienced mothers how 
they should put the baby to the breast. 

The breasts should be given alternately only one 
at a nursing, except in the rare cases where the 
physician orders otherwise, for some good and suf- 
ficient reason. 

When the mother wants to nurse her baby in bed, 
she turns over slightly to one side, her back pro- 
tected by a pillow, the baby rests on the correspond- 



7 o THE CHILD IN HEALTH AND ILLNESS 

ing lower arm, the free upper band grasps the lower 
breast and guides the nipple and part of the areola,' 
the deeply coloured region around the nipple, into the| 
baby's mouth, at the same time keeping the breast 
itself away from its nose so as to keep the nose free 
for breathing (see Fig. 24). 

At first this is not quite easy, when both the 
mother and the infant are inexperienced ; but with a 
little patience and by assuming the position just de- 
scribed they will learn it readily. In the beginning 
it is also advisable to express a few drops of milk to 
teach the infant what the whole procedure is meant 
for. 

When the mother wants to nurse the baby in a sit- 
ting position, she sits in a low chair with a comfort- 
able back and places the infant across her lap, so 
that its head lies upon the knee corresponding to the 
breast which she intends to give, the foot of this 
side resting upon a foot-stool to bring the baby's 
head opposite the breast. The corresponding hand 
supports the baby's head, while the thumb and fore- 
finger of the other hand guide the breast into its 
mouth, at the same time keeping its nose free (see 
Fig. 25). 

A mother who has been taught how to hold her 
infant during the nursing will be spared a great deal 
of fruitless work and anxiety and she will also be 
less liable to the backache which frequently accom- 
panies these first efforts. By making it as easy as 
possible for the little one she will also experience 
less trouble from his refusing the breast. 



THE FEEDING OF INFANTS 71 

Usually between the second and fifth day after 
the birth of the child the milk begins to appear in 
the breasts and at this time the breasts frequently 
swell considerably. This may be accompanied by a 
feeling of fulness and pain in the breasts and also 
by a swelling in the armpits; even a slight rise in 
the temperature may be observed. A snug, well- 
fitting bandage which keeps the breasts upward and 
inward will add greatly to the comfort of the young 
mother. 

In some cases it may take a good deal longer, even 
as long as six weeks, before the milk is present in 
sufficient quantities, and in these cases a very con- 
siderable amount of patience and persistency is re- 
quired, both on the part of the mother and the at- 
tending physician; but great will be the joy when 
success at last crowns their faithful efforts. 

The length of a meal at the breast should not ex- 
ceed fifteen minutes as a rule. Careful weighing of 
a number of babies has shown that they take three 
quarters of the amount they need during the first 
eight to ten minutes of each nursing and the rest dur- 
ing the next five minutes; while the nursing, if it 
was continued any longer, would not do the infant 
any good and would get it into the bad habit of going 
to sleep during the act; it would also tire out the 
mother. Should the breasts give off large quantities 
of milk and this very easily, then the length of a 
meal may have to be shortened by the physician. 

The amount which the child should receive at each 
meal varies, naturally, within considerable amounts 



72 THE CHILD IN HEALTH AND ILLNESS 

according to the age and weight of the infant. B; 
the end of the first week it will take about a pim 
daily, that is about three ounces at each feeding. A 
the end of the first month twenty ounces daily or| 
four ounces at each feeding ; at the end of the secon< 
month about twenty-seven ounces daily or five andl 
one-half ounces at each feeding; at the end of the 
third month thirty ounces daily or six ounces at each 
feeding ; at the end of the sixth month seven ounces 
at each one of four breast-feedings, the fifth meal 
being supplied otherwise as we will explain later. 

A simple way of figuring out how much a baby of 
a certain weight should be getting at the breast is 
as follows : A healthy baby should receive two and 
one-half to three ounces of breast-milk for each 
pound of its weight up till the time it weighs eleven 
pounds or over, but it should not be given more 
than about thirty-five ounces of breast-milk a day. 

The same number of nursings as described for 
the new-born, namely five a day, at 6 and 10 A. M. 
and at 2, 6 and 10 P. M., are given all through the 
nursing period ; nothing is to be given at night. This 
is the most effective regime in every way and will 
prove successful in almost all cases. The baby will 
receive plenty of nourishment for its growth and 
increase in weight and we take away all chance of 
its suffering from overfeeding, which is the most 
frequent source of trouble in infants. 

AVe know from experience that it will take the in- 
fant's stomach about three and one-half hours to 
digest a breast-meal, and to move it down into the 



THE FEEDING OF INFANTS 73 

ntestine for further digestion and to be taken up 
nto the system. It stands to reason that the stomach 
)f an infant will need some rest between feeding 
periods the same as that of the adult ; therefore the 
? our-hour interval which has been introduced from 
ibroad, and which is finding great favour wherever 
t is introduced over here, is the most natural and, 
it the same time, the most hygienic system of nurs- 
ng an infant. 

At night the infant does not need any food. This 
ong rest of the digestive apparatus is necessary to 
nsure its proper working. Should the baby cry a 
ittle in the middle of the night we give it some 
water and it will soon fall asleep again. 

The results of this schedule are most happy both 
is far as the babies and the mothers are concerned. 
The former are quiet because they are contented 
ind well fed ; they do not have to get rid of an over- 
abundance of food by spitting it up, and any ap- 
parently healthy baby which spits up some of its 
food is overfed ; they get an early training in regu- 
larity which will be of the greatest importance for 
their whole lives ; they get the necessary amount of 
sleep, both in daytime and at night, which they can 
not obtain when they are fed oftener, because, for 
one thing, the frequent act of nursing deprives them 
of a considerable amount of sleep, and for the other, 
the overloaded condition of their stomach gives them 
the colic and gripes which prevents their sleep so 
frequently during the better part of the night. 

The writer has on numerous occasions been called 



74 THE CHILD IN HEALTH AND ILLNESS 

to examine infants who were considered to be eithe 
nervous or ill, because they were crying sometime 
all night, while in daytime they were too exhauste 
to nurse properly and often fell asleep during' th 
act; on placing these infants on the four-hou 
schedule, five times in twenty-four hours with a ful 
night's rest they took on a decided change for th 
better at once and developed into healthy and well 
behaved babies, to the astonishment and satisfactio 
of their worried mothers. 

As far as the mothers are concerned, this regim 
will appeal to every one of them who has oncd 
tried it. It will give them the necessary time 
for their housework as well as for their social 
duties and their recreation, and will thus free them 
from a kind of slavery which is without the least 
doubt one of the reasons why so many mothers still 
object to nursing their infants. It will also insure 
for them a sufficient amount of sleep, lack of which, 
undoubtedly, is one of the most frequent causes for 
an insufficiency in her milk supply. 

The objections which are most frequently offered 
to this schedule have, upon careful investigation, 
been found to be groundless. The writer has heard 
frequently from the mouths of physicians that it 
can not be carried through because the mothers 
would not do it nine times out of ten ; they attribute 
to the women of to-day and in this country a great 
deal less intelligence than they possess. The real 
reason is that they either have not tried it at all, 
or that they are so half-hearted or so unconvincing 



THE FEEDING OF INFANTS 75 

in their advice that its true advantages are not un- 
derstood. 

In his work in infant welfare stations the writer 
has been almost universally successful in carrying 
this through with hundreds of nursing mothers, and 
this to their greatest satisfaction as well as his 
own. We must remember that the women who come 
to these benevolent institutions for advice are by 
no means recruited from the most intelligent strata 
of society ; many are foreign born and a large num- 
ber do not even understand English and must there- 
fore be instructed by means of an interpreter. They 
frequently have many other children at home, have 
to do their housework and their washing, and per- 
haps keep boarders besides. Add to this that they 
usually nurse the baby every time it cries, and we 
will understand that their lot is by no means an 
easy one and they will be ready to listen to any ad- 
vice how r they can be spared the deadly drudgery 
which is usually their fate ; that they will be able to 
preserve the bloom of youth on their cheeks and thus 
retain their attractiveness for their husbands ; that 
they will be able to be a companion to them instead 
of driving them to the saloon to talk to somebody 
after the monotony of the day's labour. But we 
must be convincing and we must go into every detail 
of the day's routine. 

She is to nurse her baby at six in the morning 
and then put it back into its crib. She has now 
time to dress, to prepare breakfast and to get the 
older children off to school. Then she bathes and 



76 THE CHILD IN HEALTH AND ILLNESS 

dresses the baby for the day, nurses it at ten an< 
then lias a chance to go and do her marketing o: 
to do some washing; she gets the lunch ready and 
washes the dishes before she nurses her baby again 
at two in the afternoon; from then until six in the 
(veiling she has time for some sewing or ironing or 
a walk with the baby and the cooking of the dinner; 
then she nurses the baby at six, puts it to bed and 
now she can enjoy her dinner with her husband and 
children; she has the evening for herself and as 
soon as the baby has been fed at ten she can enjoy 
her well-earned, undisturbed night's rest. Let us 
only place these advantages in their true light, then 
we will succeed, and our thanks will be the smiles 
on their faces and the improved health of the baby 
at the same time. 

And we do not have to confine our argument to 
the women of the labouring classes; let us take the 
other extreme, the healthy society or college girl 
who is accustomed to a great deal of outdoor exer- 
cise and who has a natural craving for the com- 
panionship of her own sex. Why should the con- 
summation of the marriage to the man of her choice 
and the arrival of the first and perhaps subsequent 
babies deprive her of all that to her held some in- 
terest in life, why should she forego all pleasure 
and even the strength and health-giving sport which 
has made her the beautiful creature that everybody 
admires; why should she degrade herself to the com- 
mon drudge who hardly has time to dress and w r ho 
when evening comes is too tired to talk and would 



FrOT'RE 2T>. BREAST SHIELD 




Figure 27. breast pumps 



THE FEEDING OF INFANTS 77 

rather go to bed after dinner and let her husband go 
to the club? What more natural, if not pardonable, 
reason could there be for her to avoid her doing her 
full duty towards her baby? But let us explain to 
her how the best method of nursing is not only the 
best for the babv but is at the same time also the 
one which will make it possible for her to get some 
enjoyment out of life, and, as is the fact, that if she 
will nurse her baby this will not only not detract 
from her beauty but wall actually enhance it; few, 
very few, will be the young mothers who will not 
listen to this line of argument and w r hom we will 
thus be able to induce to do their full duty towards 
their own flesh and blood. 

The objections to a mother nursing her baby are 
few and the decision should always be left to the 
physician. Nervousness of the mother, which is 
frequently brought forward as an excuse, can not 
be regarded as such, and the old notion that this can 
be transmitted through the milk to the infant does 
not hold good. Nor is anemia to be considered as a 
valid excuse ; many a mother who is anemic will re- 
gain her colour while nursing. A feverish disease 
is as such no excuse either nor is the return of men- 
struation which will show up in fifty out of one hun- 
dred nursing women and which has not the baneful 
effect on the quality of the milk it was supposed to 
have. 

Any woman who is strong enough to carry a child 
for nine months and to feed it with her oivn blood 
during this time will practically always be strong 



78 THE CHILD IN HEALTH AND ILLNESS 

enough to nurse it afterwards, for some time at 
least. 

We will refrain from enumerating the different 
diseases which might prevent the mother from nurs- 
ing the infant and where the physician will have 
to reserve for himself the decision. One disease will 
and must, absolutely, be considered as a contrain- 
dication, namely consumption. A tubercular mother 
must not only forego nursing her infant, but it is 
advisable to remove it entirely from her because 
infants are very easily infected with this disease 
which in the young is absolutely fatal. 

The breasts themselves may make nursing diffi- 
cult. In a few women the breasts may be under- 
developed and, though they look to be of normal size 
or even excessively large, the largest part be made 
up of fat, and they may be so deficient in the milk- 
producing tissues as to make them unproductive ; but 
these cases are comparatively rare. 

The cases in which the nipples are not sufficiently 
developed or in which they may even be drawn in 
will not be met with quite as frequently if proper 
attention is directed toward this abnormality in 
young girls and early during pregnancy; these cases 
will, however, be enabled to nurse by the aid of one 
of the several kinds of rubber nipples or breast 
shields (see Fig. 26). 

Cracked nipples may also be a severe hindrance 
to nursing owing to the pain which they cause, which 
may at times be excruciating. Proper care of the 
nipples during pregnancy will be the best preventa- 



THE FEEDING OF INFANTS 79 

tive. Once the nipples are cracked certain appli- 
cations prescribed by the physician will help ma- 
terially, as will also nipple shields. 

Mastitis or inflammation of the breast does not 
necessarily prevent the nursing at this breast, 
though it may be painful for a time ; proper care and 
treatment will in most cases restore the breast to 
normal conditions. 

In some cases, especially in women with their first 
babies and where the woman has been in poor health 
while carrying the child, the milk may not be pres- 
ent in sufficient quantities for days and even weeks ; 
in some of these cases as much as six weeks may 
elapse or even more before the mother has enough 
to satisfy her baby, but we must not despair in these 
cases nor must we give up too readily; we will fre- 
quently succeed, just as we will often be able to 
bring back a sufficient supply of milk in some of 
the cases in which the baby has been taken away 
from the breast several weeks before for some in- 
valid reason. 

To do this we will have to put the infant to the 
breast at the appointed hour and let it take what it 
can get, and then, but then only, we give it some 
additional food in the bottle. What to give in the 
bottle must be left to the physician. How" much to 
give can only be determined by careful weighing be- 
fore and after each and every nursing, and then giv- 
ing only so much as to make up for the actual de- 
ficiency, because the danger of overfeeding is very 



80 THE CHILD IN HEALTH AND ILLNESS 

great in this kind of combined feeding, or, as it is 
called by the French, " allaiternent mixte." 

In those cases in which the mother has a suffi- 
cient milk-supply, but in which the baby is too weak, 
frequently because it came prematurely, to draw it 
himself, we make use of one of the many different 
kinds of breast-pumps (see Fig. 27), from which the 
infant can either draw the milk directly w r hile the 
mother is withdrawing it from her breast, or from 
w T hich it can be transferred into a bottle, spoon or 
dropper to be fed to the infant. 

WET-NURSING 

Some infants are either too lazy or too weak to 
exert sufficient strength to keep the breasts going; 
in these cases it is a good plan to take a wet-nurse 
together w r ith her baby into the house for a few 
weeks. We let the w^eak baby nurse at the breasts 
of the w r et-nurse, while her strong baby sucks at the 
breasts of the young mother, thus supplying suffi- 
cient stimulation to cause their increasing flow of 
milk, while it can make up the deficiency in its nour- 
ishment at the breasts of its own mother, after its 
foster-brother had its quotum. As soon as the 
breasts of our baby's mother are able to furnish 
a sufficient and easily flowing supply and her baby 
is strong enough to obtain enough for himself, we 
may dismiss the wet-nurse. 

This method of wet-nursing is very efficient in a 
great many cases in which we would otherwise have 



THE FEEDING OF INFANTS 81 

had to resort to outright wet-nursing, which is inhu- 
mane, to a certain extent, as it deprives the infant 
of the wet-nurse of its own rightful food, and in 
many cases leaves it to the same dangers from which 
we try to save our little patient, or in which we 
would have to resort to the bottle and its conse- 
quences. 

Should the mother not be able to furnish any milk 
for her baby and should she still desire to give it the 
advantage of the natural food, then we can employ 
a wet-nurse. 

Wet-nursing has not become as popular in this 
democratic country of ours as it has been in the old 
world, with its different classes and castes, and this 
for very good reasons. It is without the least doubt 
an arrogance to demand from somebody else, though 
it be for a consideration, that of which they have to 
deprive their own flesh and blood in order to fur- 
nish this commodity, and it is the height of selfish- 
ness to expect this from anybody, no matter how 
poor or unfortunate, knowing, as we most assuredly 
do, the fate which so frequently awaits the child of 
the wet-nurse when it has to be boarded out and is 
fed with the bottle. 

Another great objection to wet-nursing is the dan- 
ger of transmitting disease from the wet-nurse to her 
foster-child or from the latter to the former. This 
can be obviated to a very large extent by careful 
physical examination of both, as well as of the in- 
fant of the wet-nurse and the parents of the child to 
be nursed; still, even the most painstaking and ac- 



82 THE CHILD IN HEALTH AND ILLNESS 

curate laboratory tests may fail to reveal some taint 
or other on either side which may lead to a serious 
complaint later in life. 

Far better is the most modern way of wet-nursing, 
according to which one or more nursing women with 
an overabundant supply of good breast-milk express 
some of this milk, before they put their own baby to 
the breast, into a glass, from which it is collected 
and sold to the respective customer at so much per 
ounce. This method has the great advantage that 
this breast-milk can be boiled to avoid all danger of 
the transmission of disease ; it can be stored indefi- 
nitely then in the refrigerator ; it can even be modi- 
fied to suit the needs of the recipient. 

Diet. As to the diet of the mother or wet-nurse it 
is curious to see the peculiar rules and regulations 
and restrictions which have been handed down to us 
from our forefathers and for which we know no 
good reason any more than we do for many another 
old superstition, though they still crop up time and 
again, even in medical literature. 

The nursing mother may eat anything and every- 
thing she likes and which she knows from her own 
experience to agree with her, and she can start with 
it as soon as she has awakened from the first re- 
freshing sleep after the baby is born. The mother is 
expected to get sufficient nourishment both for her- 
self and for the infant, and we can not do this by 
ordering for her a liquid diet which frequently will 
go against her; how can one imagine that she will 
have a plentiful supply of good milk when she is 




Figure 28. scales of bufi 





Figure 29. scales of Fairbanks co. 
platform scoop scale 



Figure 30. scales of Fairbanks CO., 

SCOOP SCALE 



THE FEEDING OF INFANTS 83 

ordered to partake of a special diet of overlarge 
amounts of liquid but insufficient in nourishing ele- 
ments? 

There is no better diet for nursing women than 
good every-day home cooking, with plenty of variety 
and with her favourite dishes, with due regard for 
national as well as racial and climatic likes, dislikes 
and prejudices. Every kind of good nourishing food, 
taken in moderation but still in sufficient quantities, 
which is eaten with relish will, without any un- 
founded restrictions, have the desired result. 

Result of Breast-feeding. The result of breast- 
feeding can be easily observed by the trained eye, 
and the physician can frequently tell by looking at 
a baby on the street or when he makes his first call 
if the infant has been fed naturally or unnaturally. 
The breast-fed baby has a rosy complexion, his skin 
is pink and clear of any blemishes, his flesh is firm ; 
the bottle-fed baby, on the other hand, is usually 
pale and flabby; it may be overfat, but its skin is 
little resistant to infections. 

The best criterion of the success of breast-feeding 
is the steady gain of the baby as determined by the 
scales. Spring scales are not good for this purpose 
because they are not sufficiently accurate and they 
will show considerable discrepancies when the baby 
is kicking and squirming. A special baby-scale (see 
Fig. 28) or good platform (see Fig. 29) or scoop- 
scale (see Fig. 30) must be used for this purpose 
and we must be able to show by these a gain or loss 
in half-ounces. 



34 THE CHILD IN HEALTH AND ILLNESS 

The weight of the baby should be taken at the 
same time every day and under identical conditions 
with an empty stomach, best after the morning bath, 
and we must not forget that the conditions of the 
bowels and bladder, if they are full or empty, will 
make some difference. 

The record of the baby's weight is most conveni- 
ently kept in the form of a curve. In this the hori- 
zontal lines determine the weight, the vertical lines 
the date. These charts should be so arranged as to 
show the increase in weight in half -ounces, and the 
progress in time by days or weeks, but the chart 
must be continued the way it was started, so that 
the interval between two lines always means the 
same difference in weight or time ; otherwise it will 
become meaningless. As a rule it will be sufficient 
to weigh the baby once a week; if it should become 
necessary for some reason or other to weigh the 
baby daily for a short time a new chart should be 
started for this and the weekly weights drawn in the 
old chart. These charts can now be bought very 
cheaply and a few of these are appended to this 
book; they can also be very easily prepared at 
home, especially with a sheet of ruled paper of the 
kind used by engineers for their drafting. 

Charts which show the so-called normal gain of 
a baby are not to be recommended, as they only tend 
to make the mother nervous and worried; the gain 
in weight in an infant is just as much a matter of 
individuality as are weight and stature in the adult ; 
some children gain steadily and rapidly; others 



THE FEEDING OF INFANTS 85 

again may be slower at first and may make up at 
some later time; some show a steady increase in 
weight while others gain by fits and starts and their 
charts present a very irregular picture; some may 
even show a standstill at certain times, though a loss 
in weight must always be called to the attention of 
the physician. The principal point is that the baby's 
weight should have about trebled during the first 
year of its life. Nor is it advisable to compare the 
chart of a baby with that of some relative or friend, 
because this also will only cause unnecessary cha- 
grin, the more so as we are able to observe consid- 
erable differences among the children of the same 
parents. 

DIFFICULTIES IK BKEAST-FEEDING 

If an apparently healthy infant does not thrive 
at the breast, then the physician should be called 
who may be able to find some reason for this exist- 
ing before birth which may not be evident to the 
untrained eye. If this may be safely ruled out, then 
another cause for this failure to thrive must be 
looked for. It is most natural, especially in young 
mothers who have not been taught properly, to think 
that the cause for this is a deficient quality or quan- 
tity of the milk of the mother instead of the faulty 
technic. 

The physician should therefore begin w r ith re- 
hearsing the whole procedure of nursing and mak- 
ing the mother show him how she goes about it, 



86 THE CHILD IN HEALTH AND ILLNESS 

watching her as well as the infant, because it is a 
well-known fact that some babies learn only very 
slowly how to nurse and some others seem to lack 
the proper nervous mechanism or instinct. He 
should also examine the breasts to see that the nip- 
ples are of a sufficient size and free from cracks, 
as in this latter case the pain caused by the act of 
nursing may cause a nervous holding back of the 
milk on the mother's part, which can easily be rem- 
edied by a few applications which heal the cracks. 
Special attention must also be paid to the position 
the mother occupies during nursing. If, after rem- 
edying all these points, we still find that the baby 
is not thriving, then the physician undertakes the 
examination of the milk. 

It is quite easy to find out how much the baby is 
getting at the breast by weighing it before and after 
each and every nursing for at least three consecu- 
tive days and adding the daily amounts (see Fig. 
31), and comparing these with the amounts a healthy 
baby of the same age and weight should take. Dur- 
ing this systematic weighing, which can naturally be 
done without undressing the child, we will invariably 
find some interesting facts about the amounts the 
baby takes at different times of the day ; we will see 
that it takes as a rule its largest meal at the first 
nursing in the morning after the night's rest and 
fasting. A point well worth remembering is this, 
that a baby which does not get enough at the breast 
will soon go to sleep because it is tired out by its 
fruitless efforts, but will awaken again before long 



THE FEEDING OF INFANTS 87 

with a loud, hungry cry; its abdomen will be flat 
and drawn in; its urine will be scanty and its stools 
wall be less in number than normal, small, dark and 
brown. 

The quality of the breast-milk can only very rarely 
be proven to be the cause why the infant is not thriv- 
ing. The w r ay to find this out is by taking samples 
of equal quantities, perhaps a teaspoonful or two, 
before and after each and every nursing during one 
day, mixing exactly equal amounts of these and hav- 
ing this sample tested the same as cows' milk; in 
order to arrive at figures w T hich would be of some 
value this should be done for three consecutive days, 
so as to eliminate the possibility of error accruing 
from any daily variations which in some cases may 
be quite considerable. 

The old-fashioned method of examining the milk 
by having the physician or the nurse express a little 
of the milk into a test-tube at any time during the 
day and having this looked at with the microscope 
or subjected to a chemical test, was worse than use- 
less and only a waste of time, as it could give an 
idea of that particular sample only, which might 
contain much or little cream according to the time 
it was drawn. If it happened to be drawn before 
the baby had nursed it would contain little cream, if 
after the nursing large amounts ; it would also make 
a great difference if it was drawn in the early morn- 
ing after a night's rest or later in the day; accord- 
ing to these circumstances the amount of cream in a 
woman's milk may vary from one per cent to six 



88 THE CHILD IN HEALTH AND ILLNESS 

or more per cent of cream at different times during 
one and the same day. Nor was the physician able 
to tell anything about the other constituents of the 
milk by this obsolete method. 

The most frequent reason why a baby is not thriv- 
ing at its mother's breast is, however, found in an 
overabundant milk-supply. These infants spit up 
some of it usually soon after nursing; their sleep 
is restless; they cry because they are troubled by 
wind, the so-called colic ; they urinate too much and 
too often ; their stools are more frequent and larger 
than normal. In these cases the child should not be 
allowed to nurse for its full fifteen or twenty min- 
utes, but only long enough to get the proper amount 
which can easily be determined by weighing before 
and after each nursing. Some infants get sufficient 
in from seven to eight minutes. 

It is a remarkable fact, however, to observe how 
the mother's breasts adapt themselves to the needs 
of the baby in most cases and vice versa. This we 
can see when we give a young infant to a wet-nurse 
w T hose baby is several months older. At first she 
will naturally have too much for her little charge, 
but in a comparatively short space of time her 
breasts will give no more than the infant requires 
and can take. 

As long as there is too much milk in the breasts 
for the particular baby the breasts should be pumped 
out after each nursing, as otherwise they might go 
dry altogether. 



THE FEEDING OF INFANTS 89 

« 

COMBINED FEEDING 

This form of feeding is a transition from the nat- 
ural to the unnatural feeding and it consists in a 
combination of the two. 

Its use is not yet as general as it deserves to be. 

In all those cases where the mother has not enough 
milk or where she is prevented by work to give the 
entire food from her own breasts, it is of the great- 
est importance for the infant to give it as much 
breast-milk as possible and to make up only the de- 
ficiency with the bottle. 

This should always be done under the direction of 
the physician, who is alone able to determine how 
this should be done and what the baby should be 
given in the bottle. We may give the breast first 
and then the bottle or we may give the bottle and 
breast alternately. 

If we give the breast at each feeding and the bot- 
tle afterwards the amount of breast-milk which the 
baby receives at each feeding must be determined 
with the scales, by weighing before and after each 
nursing for some days so that we can tell how much 
the baby must be given with the bottle in order to 
get a sufficient amount of food. If the breast and 
the bottle are to be given alternately the physician 
must decide how many bottles a day will be re- 
quired. The amounts to be given in the bottle in 
both methods of combined feeding must be regulated 
and changed at frequent intervals to suit the baby's 



90 THE CHILD IN HEALTH AND ILLNESS 

age and weight and also according to the breast- 
milk it is given. 

A point of great importance is this, that the hole 
in the rubber nipple on the bottle should be suffi- 
ciently small so that the baby has to work to get its 
food out of it, because if the food should come too 
easily out of the bottle the child may soon refuse 
the more laborious breast-feeding. 

Women who have to work away from home in day- 
time might nurse the infant at six A. M. and at six 
and ten P. M. and have the bottle given at ten A. M. 
and two P. M. Far better, however, would it be if 
we could compel, by legislation, all employers of 
women to have special rooms wdiere they could leave 
their babies and nurse them; this is done in some 
countries, notably in France. 

Mothers of twins who have not sufficient milk for 
both babies may be enabled by this method to let 
both of their infants receive the benefit of breast- 
milk by putting their babies to the breast alternately 
and feeding them with the bottle in between. Thus 
one baby would get three breast-feedings and two 
bottles one day and two breast-feedings and three 
bottles on the next and the other vice versa. 

WEANING 

It is not advisable to feed a baby at the breast 
exclusively for longer than six months, because it 
may show signs of impaired health, such as paleness, 
constipation, bad temper and lessened liveliness; 



Date 



Hour 



Weight 

before After 



1 fas oz 



lbs 



oz 



Amount 
Ounces 



Ounces 



6.A.M 



10. AM 



2PM. 



6.PM 



10. PM 



)ailyyAmount 





6A.M. 
















10A.M. 
















2.RM. 
















6.RM. 
















10.P.M. 
























)aily Amount 







6AM. 
















10A.M. 
















2.PM. 
















6.PM 
















10.PM. 
























}ailyAmount 





3 Day Nursing record 



Figure 31. 



THE FEEDING OF INFANTS 91 

;his will be the more evident the longer exclusive 
xreast-feeding is persisted in. 

The anemia can be easily explained by the almost 
nfinitesimal amounts of iron contained in the breast- 
nilk. The infant has enough reserve iron in its 
>ody to last him for the first six months, but after 
his it needs more iron, which can only be given by 
idditional feeding. 

At the completion of the sixth month the baby is 
^iven, twice a day, at nine A. M. and at five P. M., 
3ne to two teaspoonfuls of the juice of sweet, ripe 
oranges,* without the addition of sugar and from 
ruit which is not overripe. Should the oranges be 
sour the juice may be sweetened by the addition of 
l little baking powder. Oranges are best because 
heir juice can be easily expressed and because they 
an now be purchased in this country the whole year 
iround ; they also seem to agree best with most in- 
fants. Scraped sweet apples f are also good. The 
nely grated peels of oranges with twice the amount 
of water and a little sugar may be used as a cheap 
md efficient substitute for the juice of the oranges, 
ilso potato-water.* 

As soon as the baby is accustomed to the fruit- 
juice it is given in the place of the nursing at two 

. M. a pap consisting of two teaspoonfuls of farina 
3r cream of wheat, or three rolled zwieback cooked 

one-half pint of the best cows' milk.f 

During the eighth month another feeding with the 

*See recipes, page 284. 
fSee recipes, page 285. 



92 THE CHILD IN HEALTH AND ILLNESS 

spoon can be added daily instead of another breast- 
feeding, and the writer has found vegetable soup 
to be best for this. The dietary for a baby would 
then be as follows: At six A. M., breast; at nine 
A. M., orange juice ; at ten A. M., pap ; at two P. M., 
breast ; at five P. M., orange juice ; at six P. M., vege 
table soup ; at ten P. M., breast. 

During the ninth month another breast-meal is 
supplanted by a feeding by hand; this consists of 
cows' milk either plain or modified and should be 
given in a cup, but if this proves too difficult it may 
be given in the bottle instead of the two P. M. nurs- 
ing; so that the baby is now nursed only twice a day, 
best at six A. M. and at ten P. M. 

When the baby has completed its ninth month it 
should, as a rule, be weaned altogether, as this can 
now be done without any detriment. If it was ac- 
customed to take its liquid food from the bottle be- 
fore, it can now be weaned with the cup and need 
no longer be given the bottle. According to the 
directions of the physician the baby is weaned to 
whole cows' milk or to one of its modifications. 

This gradual mode of weaning is best for both the 
mother and the child. The former does not suffer 
from the tension in the breasts which would occur 
if the weaning were done suddenly; the milk gradu- 
ally diminishes in amount with the lessened demand 
for it. The baby gets slowly accustomed to this, now 
natural, mode of feeding and it can gradually adapt 
its digestive apparatus to this new way. The breast- 

* See recipes, page 285. 



THE FEEDING OF INFANTS 93 

milk will agree with any other food that we may 
give and it will even enhance its value. 

Naturally no hard and fast rules can be given 
about weaning nor about what to give as additional 
feeding, and it is always best to procure the phy- 
sician's advice in this. 

It is not advisable to wean an infant altogether 
during the hot summer months, nor to make any ma- 
terial changes in its feeding during this time, as it 
is better to reduce the food during the hot months 
and to give more water. 

Also all changes in the baby's diet should be made 
gradually and the milk should be kept in the breasts 
until we are sure that we have no longer to resort 
to it. 

UNNATURAL FEEDING 

The term "unnatural feeding" has been chosen 
in preference to that of "artificial feeding" which 
is usually employed, in order to emphasise still more 
the fact that this form of feeding, before a certain 
age, is contrary to nature and that it is therefore 
bound to expose the infants to some at least of the 
bad effects of any measure which is not intended for 
it by the natural and common course of events. 

As stated before, ninety out of every one hundred 
mothers are able to and therefore should nurse their 
babies, but the remaining ten per cent will now de- 
mand our attention. "We will first consider the gen- 
eral rules according to which we may expect to have 
some measure of success; we must, however, never 



94 THE CHILD IN HEALTH AND ILLNESS 

lose sight of the fact that the unnatural feeding of 
infants is, at its best, only a makeshift, and a poor 
one at that ; that it is one of the most difficult chap- 
ters of the practice of medicine ; and that in order 
to be safe it must be left entirely to the judgment 
of a physician, preferably the children's specialist, 
who is familiar with it in all its phases. 

We know that many an infant is reared without 
ever receiving a drop of human milk, but this proves 
only that the natural resistance and the adaptability 
of its organism are very great, and it does not con- 
trovert by any means the fact that the majority of 
infants do not possess this faculty and that they 
are less resistant to diseases of all kinds. 

The clearest proof for these statements is found 
in the mortality statistics which show that at least 
ten times more bottle-babies die than breast-babies 
during the first year of their lives. 

The usual substitute for human milk is cows' milk, 
and a glance at the chemical composition of the 
two will show their material difference in more than 
one respect. We will find that human milk contains 
half again as much sugar as does cows' milk; that 
the albuminous contents of cows' milk are more than 
twice those of human milk; and that cows' milk con- 
tains about four times as much salt as does human 
milk. 

Without going into any details it will be obvious 
that these differences appear perfectly natural, if 
we will only consider that cows' milk is the natural 
food of the calf which can run around soon after 



THE FEEDING OF INFANTS 95 

birth, which has a natural protection against the loss 
of heat from its body in its coat of fur and which is 
growing comparatively rapidly. 

One other fact, which, however, is not obvious 
from a comparison of the chemical composition of 
the two kinds of milk, is this, that cows' milk will 
confer a certain amount of protection against infec- 
tious diseases to the calf but not to the infant, which 
latter can obtain this protection only from the milk 
of its own species, from human milk. 

The breast-fed infant obtains a food which has 
the exact composition intended by nature for an or~ 
ganism which is weak and the digestive apparatus 
of which is not yet fully developed ; this food leaves 
the breast at the right temperature in a clean, un- 
adulterated condition and it has to be drawn out of 
the breast by the laborious method of sucking, which 
not only prepares the digestive apparatus so that it 
can take care of it, but by tiring out the child it 
gives some guarantee against the dangers of over- 
feeding. 

Not so the bottle-baby. This receives a food which 
demands considerably more work from the digestive 
apparatus of the child, without, at the same time, 
being as easily digested. This food does not always 
come from healthy animals and it may therefore 
contain the germs of diseases. Instead of its being 
fed directly from the animal's udder, the way the 
calf gets it, it is drawn by the unnatural method of 
milking, during which it is exposed to contamination 
with germs not only from the hands of the milker 



96 THE CHILD IN HEALTH AND ILLNESS 

and from the coat of the cow and the air of the 
stable, but it may be infected with the germs caus- 
ing tuberculosis, typhoid fever, diphtheria or scarlet 
fever, which the milker may carry in his system 
without being aware of this. After milking the cows' 
milk passes through different containers of more or 
less doubtful cleanliness, and hours will usually 
elapse before the baby gets it, during which time the 
germs can multiply in numbers incredible to and 
inconceivable for the lay-mind. 

The best and highest-priced milk w^hich can be 
bought and which has been obtained under the most 
elaborate precautions will very rarely contain less 
than five thousand germs in less than a quarter of a 
teaspoonful of the milk, while ordinary milk may 
contain anywhere from fifty thousand germs up into 
the millions in the same amount. 

A great deal therefore depends upon the source 
from which the milk for the baby is obtained, though 
not quite as much as physicians have taught the pub- 
lic to believe, because the time is past when every 
digestive disturbance in an infant was attributed to 
the action of germs and to the contamination of the 
milk with these. 

It has been learned that the most important point 
in the unnatural feeding of infants is the compo- 
sition of the food, and this is still further proven 
by the fact that many an infant which has never been 
given anything but the most expensive and, at the 
same time, the most carefully procured and kept 
milk, which was shown by regular examinations to 



THE FEEDING OF INFANTS 97 

contain comparatively few germs only, has still suf- 
fered from the most severe and even fatal digestive 
troubles. 

The recognition of these facts has led to the 
adoption of the most diverse, and sometimes the 
most fanciful and absurd, modifications of cows' 
milk advocated by different pediatrists. Some of 
these modifications are so complicated that it is al- 
most impossible to teach the mother or nurse how 
to prepare these in the home, and various kinds 
of jars and measures and rotary indicators have 
been placed on the market, in order to make this 
easier, which they have by no means done. 

Then came the manufacturers of patented and 
proprietary foods, the number of which is legion. 
These try to tell us in their blatant advertising in 
the daily press and in magazines, especially in those 
intended mostly for women, and also in their "won- 
derful" little illustrated booklets which they send 
out broadcast and which they enclose in every one 
of their packages, how simple it is with the use of 
their own particular product to make cows' milk 
equal to or even better than mothers' milk. Who 
pays for this advertising campaign? Does any one 
think for one moment that the manufacturer is in 
this business for humanitarian reasons and not for 
the money he can extract from the pockets of the 
unwary? If a member in a family were suffering 
from typhoid fever or pneumonia would they buy 
some patent medicine and attempt to treat the pa- 
tient according to the directions contained in the 



98 THE CHILD IN HEALTH AND ILLNESS 

folder accompanying it? Of course not. Why then 
should the ignorant and greedy manufacturer be 
permitted to teach physicians and mothers how to 
feed babies? 

The one most important ingredient required for 
the unnatural feeding of infants is what the Lord 
has given to almost everybody — Common Sense. 

This should always be employed when one delib- 
erates about what to feed a baby. 

The baby must not be fed formulae but good, sen- 
sible combinations of food elements in their proper 
proportions. 

It must be remembered that one has to deal with 
individuals, infants though they be, who have their 
likes and dislikes and their idiosyncrasies the same 
as adults and that these may be either acquired or 
inherited. 

It must be remembered that one has not got to 
deal with pieces of machinery about which one can 
say beforehand that they will need so much fuel or 
so many volts to get the desired results. 

This must be kept always before one's mind and 
one must refrain from any rigid system of feeding 
infants ; then, and then only, will one be successful 
in most cases, provided one remembers the few gen- 
eral rules now to be enumerated. 

The key-note of successful infant-feeding is to 
keep always before one's mind the fact that the baby 
requires three ounces of liquid — mind liquid, not 
milk or other food — for every pound of its weight 
up to forty ounces daily. That means that when the 



THE FEEDING OF INFANTS 99 

child 's weight will have gone up to and above eleven 
pounds we may give the limit of forty ounces, but 
not more. 

One must further remember that in order to thrive 
and to grow the infant requires not less than forty- 
five calories per pound of its weight, regardless of 
what that weight might be. One must find out, how- 
ever, first of all, what the baby's digestive apparatus 
can take care of, and then, but then only, may one 
figure out for one 's own satisfaction if this food rep- 
resents the necessary quantity of calories. 

In summer the infant requires more water, the 
same as every one else does, but not too much of it, 
because this excess would have to be eliminated, not 
as plain water but as urine, which is a solution of 
salts of which the body of the infant would conse- 
quently be deprived. 

One must also get away from the old and worn 
notion that summer is the worst time for the baby 
and that digestive disturbances in infants will be ob- 
served during that season only. True, more infants 
die during the hot summer months, but the moist 
heat is only the last straw in an already impaired 
system, the foundation for which was laid during 
the other months. The pediatrist, the children's 
specialist, sees more of these cases in winter, when 
the confinement in the bad air of our overheated and 
underventilated houses exerts its bad effect. 

The composition of the food for the baby may be 
near that of human milk but not necessarily so, and 
one will observe frequently that a baby will thrive 



ioo THE CHILD IN HEALTH AND ILLNESS 

on a food which is of an entirely different compo- 
sition. 

Of the different elements of the food the proteids, 
the albuminous part, are the least dangerous and 
they can therefore be given in comparatively large 
quantities. 

The carbohydrates, comprising the starches and 
the sugars, can be given up to one-tenth of the whole 
food. The starches are given in the form of cereal 
decoctions, especially barley and oats. The sugars 
used in infant-feeding are milk-sugar, cane-sugar 
and malt-sugar. Of these the milk-sugar, which is 
found as a natural ingredient of human as well as 
animal milk, is the hardest to digest for the baby 
when added to an artificial food, and many physi- 
cians use it less all the time for this reason; the 
writer has not prescribed milk-sugar for many 
years and attributes a considerable amount of his 
success in feeding babies to this fact. Cane-sugar is 
easier digested by infants, but in many cases nothing 
will equal the effect of the addition of malt-sugar to 
the food. It has also been learned, from experience, 
that two different carbohydrates act better than only 
one in the food ; this may explain why babies thrive 
better when we add malt-sugar to the food which al- 
ready contains milk-sugar in the cows' milk, and it 
has further led to the addition of cereal decoctions 
which has proven so successful. 

Fp,t, cream, is now universally considered the most 
dangerous element of the food and the one with 
which one has to be extremely careful in its adminis- 



THE FEEDING OF INFANTS 101 

tration. This is the reason why top-milk mixtures 
and cream mixtures are now being given up by so 
many physicians and why they warn against the 
use of rich milk, as, for instance, Jersey milk for 
babies and advise instead the use of the milk from 
Holstein-Friesian cattle, which contains pretty uni- 
formly three and one-half per cent of cream. Per- 
haps it is not generally known that Jersey calves can 
frequently not be raised with the milk of their own 
mothers because this is too rich for them, but have 
to be fed on the milk of another cow of a breed which 
furnishes a milk which is less rich. 

Sick babies whose digestion has been impaired 
and who cannot digest cream, the writer has started 
for some years from an almost fat-free food, such as 
skim-milk or buttermilk, and this with the best of 
results; on the other hand he has seen many an 
infant in whom a pronounced idiosyncrasy against 
cream, a peculiar susceptibility, had been brought on 
by the injudicious administration of this fact ; with 
the result that the infant will show symptoms when 
we increase the cream in its food even slightly. 

It is always safer to underfeed an infant, at least 
until one has had time to find out what its digestive 
apparatus can take care of, rather than to start with 
full quantities and to learn then, to one's regret, 
that valuable time has been lost, because the baby 
can not stand this strong food and that a weaker 
one has to be given after all. 

Boiling the milk quickly, but not longer than three 
minutes, is now advised by many, but this is not done 



ioo THE CHILD IN HEALTH AND ILLNESS 

on a food which is of an entirely different compo- 
sition. 

Of the different elements of the food the proteids, 
the albuminous part, are the least dangerous and 
they can therefore be given in comparatively large 
quantities. 

The carbohydrates, comprising the starches and 
the sugars, can be given up to one-tenth of the whole 
food. The starches are given in the form of cereal 
decoctions, especially barley and oats. The sugars 
used in infant-feeding are milk-sugar, cane-sugar 
and malt-sugar. Of these the milk-sugar, which is 
found as a natural ingredient of human as well as 
animal milk, is the hardest to digest for the baby 
when added to an artificial food, and many physi- 
cians use it less all the time for this reason; the 
writer has not prescribed milk-sugar for many 
years and attributes a considerable amount of his 
success in feeding babies to this fact. Cane-sugar is 
easier digested by infants, but in many cases nothing 
will equal the effect of the addition of malt-sugar to 
the food. It has also been learned, from experience, 
that two different carbohydrates act better than only 
one in the food ; this may explain why babies thrive 
better when we add malt-sugar to the food which al- 
ready contains milk-sugar in the cows' milk, and it 
has further led to the addition of cereal decoctions 
which has proven so successful. 

Fp,t, cream, is now universally considered the most 
dangerous element of the food and the one with 
which one has to be extremely careful in its adminis- 





FrnuRE 34. ice box 



Figure 3."i. electric bottle heater 



THE FEEDING OF INFANTS 103 

question, What kind of bottle is the best? Only such 
nursing bottles should be used which can be easily 
cleaned and which have no corners in the bottom 
where rest of food may remain. In his own family 
as well as in his practice the writer has for years 
used the straight, jar-like, correctly graduated nurs- 
ing bottle with a large nipple which can readily be 
turned inside out for cleaning (see Fig. 32). 

The rest of food which the baby did not take at a 
feeding should be thrown away and the bottle be 
rinsed at once. 

Bottles and nipples should be sterilised by boil- 
ing every time before use. The bottles should be 
turned upside down after this and the nipples should 
be kept inside of a clean towel, this being prefer- 
able to their being kept in a solution, as this is 
liable to spoil the rubber. 

Not less than six bottles with their nipples should 
be kept on hand in case of breakage, and each new 
bottle should be boiled for fifteen minutes before 
using it, to anneal the glass, thus preventing its 
breaking to some extent at least. 

It is advisable to prepare the food in the morn- 
ing and to place the proper amount into each one of 
the required number of bottles and then to cover the 
bottle with a sheet of clean paper kept in place by 
a rubber band (see Fig. 33) ; the bottles are best kept 
in a special little ice-box which should be used for 
the baby exclusively (see Fig. 34). 

When it is time to feed the baby the bottle should 
be heated to 100 degrees Fahrenheit, either in one 



io4 THE CHILD IN HEALTH AND ILLNESS 



of the very handy little electric heaters (see Fig. 35) 
or by placing it into a small pitcher of hot water. 

Before giving it to the baby the mother or nurse 
must always test the temperature of the bottle by 
letting a few drops of the food fall on the back of 
her hand. 



CHAPTER VI 

THE DIGESTIVE DISTUEBANCES OF 

INFANTS 

EXPLANATION" 

SUPPOSING we give to a healthy, normal infant 
for some time overlarge amounts of breast-milk 
or of a good modification of cows' milk which has 
the right composition for the age and the weight of 
this baby, then this overfeeding, which may either 
be the result of too frequent feeding or giving over- 
large quantities at each feeding, will overwork the 
digestive apparatus. 

After a time, sometimes sooner, sometimes later, 
the infant will show by its behaviour that everything 
is not well with it. Its weight-chart will show ir- 
regularities ; it will be pale, restless and frequently 
cross; nature may try to regulate matters by the 
child's vomiting occasionally and by the evacuation 
of more frequent and larger stools. 

Now would be the time to call in the physician. He 
would recognise at once the source of the trouble and 
by regulation of the amount of food to be given and 
by lengthening the intervals between feedings he 
could soon have the child restored to perfect health. 

Usually, however, the physician is not consulted at 

105 



106 THE CHILD IN HEALTH AND ILLNESS 

this early stage ; the disturbance in the baby's health 
and behaviour is attributed to other causes, most fre- 
quently to teething, and the child's crying is attribu- 
ted to hunger; the food is still further increased, 
thus augmenting the trouble and sooner or later 
leading up to the severer grade of disturbance, a 
true dyspepsia, which is a serious condition in a bot- 
tle-baby. Even now, however, the physician could 
quickly remedy matters by the proper regulation of 
the diet of the little patient, but, unfortunately, even 
these severer symptoms are only too frequently not 
heeded or misunderstood, and when the physician is 
finally called, he finds the infant in a condition in 
which the food acts as a poison, causing severe vom- 
iting as well as diarrhea, from which the condition 
has been called cholera infantum, though these 
symptoms are only the most in evidence and by no 
means the most important. This alimentary intoxi- 
cation, as we now call it to express its origin, is very 
serious and may be fatal in a few hours ; it is accom- 
panied by sudden considerable losses in weight, a 
pound or more in twenty-four hours, and a long 
time is required before the baby will be back to nor- 
mal health. 

In other cases the condition takes a more chronic, 
though no less serious course, the infant fades away, 
it becomes extremely thin, with the wrinkled face of 
a very old person, with sunken eyes and a large red 
mouth. In this condition the infants are really hun- 
gry but their power of digesting food has been lost 
almost entirely; they live on their own body sub- 



DIGESTIVE DISTURBANCES OF INFANTS 107 

stance ; therefore this stage is now called decomposi- 
tion or atrophy. 

Much more rarely do we observe the opposite con- 
dition where the infant is suffering from underfeed- 
ing, though this may arise from an insufficient 
amount of milk that the mother can offer her child 
from her breasts or in artificially fed babies, owing 
to the well-founded fear of overfeeding on the part 
of the mother. As long as this has not lasted too 
long this will not be serious, but after a time the 
baby may get too weak to take even the little food 
offered to it. 

An infant which has been fed for too long a time 
on milk exclusively, especially one which is too rich 
in cream, or on a mixture which contains too much 
starch or sugar, or both together, such as most of the 
patented and proprietary foods, will also show se- 
vere disturbances in its health from this one-sided 
overfeeding, and no class of digestive disturbances 
is more frequently seen by the physician. The ap- 
pearance of these babies may be very deceptive ; they 
may look stout and healthy, though a little pale, but 
let these children acquire a light infection and there 
will be a catastrophe. The usual story the physician 
hears when he is finally called to see one of these 
patients is, that the child was fed one after another 
of the different kinds of modifications of cows ' milk 
and the various proprietary foods, on all of which it 
seemed to thrive for about two weeks, when a change 
had to be made for some reason or other. It is al- 
most miraculous how quickly these babies will often 



108 THE CHILD IN HEALTH AND ILLNESS 

respond to the proper administration of a well-bal- 
anced diet. 

Contrary to the opinion still held by many infec- 
tion of the stomach and intestine and the germs 
usually found in milk which has not been obtained or 
kept carefully can only relatively rarely be held re- 
sponsible for sickness in infants; much more fre- 
quent and, therefore, more important, are the #ew- 
eral infections which may attack a baby; a slight in- 
fection, such as an ordinary cold in the head which 
would at the most be an inconvenience in an older 
child or an adult, will seriously affect the digestive 
apparatus of the infant, in whom digestion and 
growth are the two most important functions of 
life ; and even an infant which has so far been per- 
fectly healthy will respond to such an infection with 
a considerable loss in weight. 

The effect of heat upon the infant is twofold. 
The high temperature and moisture in the atmos- 
phere of the summer months may cause the symp- 
toms of sunstroke ; this is mostly seen in the densely 
populated districts of our large cities where no air 
can pass through the caiioiis between the houses and 
where parks and breathing-spots are few and far 
between, where the fire-escape is often the only 
means of getting what little relief may be obtained 
and where, owing to the crowded conditions 
and the poverty, the baby has to spend its days in 
the same single room in which the washing and the 
cooking is done. 

Or, the digestion of the baby may be slightly im- 



DIGESTIVE DISTURBANCES OF INFANTS 109 

paired by the heat, and if it is given the same amount 
of food as before or if it should even receive more 
food, instead of water, it will suffer from overfeed- 
ing and its bad effects. The proper regulation of 
the baby's clothing at this time is also of great 
importance. 

The inherited and, to some extent, the acquired 
constitution of the child is also of the greatest im- 
portance, and we will, no matter how healthy a baby 
may look, never be able to foretell how it will thrive 
even at its mother's breast. These conditions are 
only now being recognised in their true light and 
their influence being duly considered. 

Needless to add that malformations either of the 
digestive tract or other parts of the body may have 
a serious influence upon the infant's digestion. 

THE TREATMENT 

In the foregoing pages the writer has attempted 
to give a clear and concise idea of the difficulties 
which confront us in the cases of these infants and 
of the complex pictures which we are liable to meet 
with. 

He has long held the view, and he has forcibly ex- 
pressed this at many occasions, that this is a field 
in which a great deal of harm can be done and is 
usually done by the laity. This is a domain which 
belongs entirely to the physician who has had the 
advantage of special training in the feeding of in- 
fants and who can note even slight changes in the 



no THE CHILD IN HEALTH AND ILLNESS 

condition of the baby, long before the mother or 
nurse realise that everything is not well. 

We have learned the lesson in other matters per- 
taining to medicine that "prevention is better than 
cure" ; why not in this which means so much for the 
future welfare of the child? 

Why should we allow the writers of little books or 
the greedy manufacturer of baby-foods to place in 
the hands of the mother or the nurse a number of 
formulae, from which to choose in a more or less 
haphazard way ; or why should we allow the grand- 
mother or aunt or even the neighbour, who claims to 
know a great deal about infant-feeding because she 
has borne a number of children, though she does not 
tell us how many of these she has lost from digestive 
disturbances — why should we let all of these give 
their gratuitous advice? Why should the mother 
wait until the baby has suffered severely in its 
health, and then only call in the physician to repair 
the damage done? 

Would it not be much more sensible to place the 
feeding of the infant from the very first into the 
hands of a competent physician, whose duty it would 
then be to see to it that the infant remains well and 
thrives in a normal way? 

Anybody who has had some experience with in- 
fants w^ill realise that this would save the mother a 
great deal of anxiety and a great many sleepless 
nights, and w r ould save the baby from many a sick- 
ness which weakens its svstem. 

This is the reason why the writer has refrained 



DIGESTIVE DISTURBANCES OF INFANTS in 

from giving any detailed advice about the different 
kinds of food to be given to babies ; in fact it is one 
of the reasons why this book has been prepared. 

The feeding of well infants is a difficult matter; 
the feeding of infants with digestive disturbances is 
extremely difficult and requires that every order of 
the physician should be carried out in its minutest 
detail and that the time for feeding should be ob- 
served by the watch. Thus only will the physician 
be able to do his very best for his little patient. In 
order to carry out the physician's orders the mother 
or nurse should ask him to write his formulae and 
his directions in the form of a prescription, and to 
write a new prescription every time he makes the 
slightest change. Only by hearty co-operation on 
the part of all concerned will the baby regain its 
health in many cases. 



CHAPTEE VII 
TEETHING 

BEFORE discussing the diseases of infancy we 
must speak of a normal process about which a 
great many superstitions and old-fashioned notions 
are still in circulation, not only among the laity but 
even among physicians — we refer to "teething." 

Many an infant will get through the first half of 
its first year apparently in perfect health, but in the 
second half it may show some disturbances which are 
really due to the change in the food owing to im- 
proper weaning, or to the bad effects of unnatural 
feeding which begin to appear only now. As this is 
also the period of life when the teeth begin to ap- 
pear, though they had been preformed long before 
this, what more natural than that every indisposi- 
tion of the infant should be referred to this normal 
process of development! 

If we were asked if teething of itself causes any 
of the diverse troubles, so frequently observed at 
this age, we would have to answer this question 
most decidedly and most emphatically in the nega- 
tive. 

True, some very few children will have some in- 
crease in salivation; they may even have an unconi- 

112 



TEETHING 113 

fortable feeling in the elevated gums, but beyond this 
nothing can be attributed to teething. In more than 
ninety-nine out of one hundred of the cases in which 
teething is accused of interfering with the child's 
health, the careful physician will be able to find an- 
other definite cause. 

The fact that teething is still so often blamed for 
all kinds of illness results in this, that the nature 
of the illness is not ascertained in time — the physi- 
cian is called in late and he has to repair the damage 
already done. 

The necklaces we see placed around the necks of 
teething infants are either relics of barbarous times, 
or are taken over from the woodoo-medicine of for- 
mer African slaves, and they are surely not a sign 
of intelligence in this supposedly enlightened age. 

The different kinds of roots and so on, for the 
baby to bite on, can as a rule not be cleaned proper- 
ly, the inflammation of the gums, and the profuse 
salivation caused by the infection from these are 
then attributed to the teething. 

If we w r ant to indulge the baby in its natural de- 
sire to chew something, we can give it something 
better and cleaner, and therefore less dangerous, in 
the shape of silver or plated spoon, naturally with- 
out sharp edges, which can be kept clean by simple 
boiling. 

So-called teething or soothing medicines can not 
be condemned too severely; there is not one of these 
but which contains some dangerous sleep-producing 
drug or quieting narcotic; numerous are the cases 



ii 4 THE CHILD IN HEALTH AND ILLNESS 

in which the writer had to use his best efforts in 
saving some little charge of his from an untimely 
death, after it had been given one of these prepara- 
tions. 

Most applications to the gums are useless and 
therefore superfluous. 

Cutting or lancing of the gums is fortunately get- 
ting obsolete, but many a child has lost one or more 
of its teeth owing to an infection in the wound thus 
produced. Moreover we will usually observe that 
the wound will be healed before the tooth has come 
through, and the resulting scar will delay still fur- 
ther its appearance. 

Let us remember therefore that babies get their 
teeth, which have been preformed at their birth and 
which are growing all the time, without any trouble 
and that the cause of an illness at this time must be 
determined by the physician, and that at once. 

Let the laity understand that any physician who 
states that a given illness is caused by the teething, 
is either too ignorant or too indolent to try to find 
out the real cause of it and that he is therefore not 
a safe person with whom to entrust the health of 
one's child. 



CHAPTER Vin 
THE PREMATURE INFANT 

THE human young born into this world ahead 
of its allotted time of nine calendar months of 
life within its mother's womb has to start the battle 
for its existence handicapped by an immature or- 
ganism. Remembering the rather large demands 
which these new duties make upon the organism of 
the infant born at term and how they tax its powers 
to the limit, we will readily understand what this 
will mean for the premature and how our efforts for 
the preservation of the little mite will be taxed to 
their limit. 

The most difficult problem confronting the organ- 
ism of the premature newborn is the maintenance of 
its body-heat. Its relative surface is considerably 
larger even than that of the mature infant and the 
chance for its giving off heat into its surroundings 
must therefore be correspondingly larger; at the 
same time the amount of protecting fat under its 
skin is considerably less and its apparatus for the 
regulation of heat is entirely inadequate. If we 
add to this that its digestive apparatus is likewise 
not yet up to the demands of independent life and 
that it can therefore digest only small amounts of 

115 



n6 THE CHILD IN HEALTH AND ILLNESS 

nourishment, while it would have to be burdened far 
in excess of its actual powers in order to make up 
the loss of energy consequent to the larger loss of 
heat, then we can fully understand and appreciate 
the problems we have to solve and the considerable 
ingenuity we have to exercise. 

Our first and principal duty consists in diminish- 
ing the loss of heat from the surface of the body of 
the newborn premature infant; this we succeed in 
doing by keeping the temperature surrounding the 
child near that of its body. We have found in prac- 
tice that the most favourable temperature lies closely 
around eighty-six degrees Fahrenheit; if the tem- 
perature should go down to less the child will react 
with a subnormal temperature of its body; if higher 
it will suffer from heat-congestion, a condition w r hich 
corresponds closely to the effect of extreme summer- 
heat in the adult. 

Even the slightest cooling, especially during the 
exposure in the bath or while these children are 
washed or changed, will not only subject them to a 
fall in their temperature, but it will also cause a 
standstill or even a loss in their weight, because the 
abstraction of heat, slight as it may appear, will de- 
prive the system of the small surplus of energy 
which could have been used for a gain in weight. 
This surplus of energy in premature infants is at 
its best only infinitesimal in comparison to their rel- 
atively large demand for food. 

The premature infant needs human milk even 
more than does the mature new r born. But the large 



THE PREMATURE INFANT 117 

amounts it would really require can not be given 
with safety during the first few days, as they would 
cause dyspepsia by overtaxing the powers of the 
weak digestive organs. We must be extremely care- 
ful with the feeding and we will have to be satisfied 
if we can give in the beginning from two to three 
ounces daily and if we should succeed in reaching 
the necessary amounts in about four weeks. The 
infant will, naturally, not gain during this time; it 
may, quite likely, loose a little in weight, but this will 
be preferable to one's taking any chances at over- 
feeding, the more so as even a slight dyspepsia may 
prove fatal. 

Breathing is frequently insufficient in the prema- 
ture and the lungs fail to expand properly as a con- 
sequence. This is recognised by the fact that the 
lusty cry of the normal newborn is replaced by a 
moaning whine and also by the blue colour of the 
skin. 

All kinds of infection, even a slight cold in the 
head, are extremely dangerous for the premature. 

Our chances of being able to raise a premature 
infant depend foremost on its weight at birth. With 
those weighing two pounds or less we will only suc- 
ceed in very rare instances, while every additional 
quarter of a pound will make the outlook so much 
more promising. The outcome depends, however, 
upon the care we can provide for these little mites, 
if we can keep them in an even and sufficiently high 
temperature and if w r e are able to prevent all forms 



n8 THE CHILD IN HEALTH AND ILLNESS 

of infection, and, last but not least, if we can offer 
them the best of food, human milk. 

From the foregoing it can be seen how much 
hinges upon the question of supplying these infants 
with sufficient heat. In hospitals and among the 
wealthy we can do this with an apparatus built upon 
the principle of the brooder, so-called incubators, 
furnished with automatic arrangements to keep the 
temperature always at eighty-six degrees Fahren- 
heit and for supplying at the same time a sufficient 
amount of warm, pure, moist air ; but these appara- 
tuses get out of order very easily and are hard to 
handle by the inexperienced (see Fig. 36). 

In his private practice as well as in his institu- 
tional work the writer has used, with the best of re- 
sults, simple incubators, with or without cover, in 
which the heat is supplied by hot water containers. 
These are easily ventilated and can be moved around 
as they stand on castors (see Fig. 38). 

Among those who are less endowed with worldly 
goods and in the country, away from the surgical 
supply-houses, one succeeds with the simplest of 
means and with material which may be at hand any- 
where. Here we wrap the child in absorbent cot- 
ton or in six layers of an ordinary woollen blanket, 
without any clothing, and we place at each side of 
the child two hot- water bottles or quart fruit-jars; 
one of these is changed every hour day and night, 
so that all are renewed in the course of every four 
hours. These heating devices must be placed outside 
of the blanket (see Fig. 37). Under these conditions 



THE PREMATURE INFANT 119 

we must naturally dispense with supplying the 
warmed air of the large automatic incubators, but 
even then our results are often excellent. 

How long should these infants be kept in the in- 
cubator ? 

As soon as a regular steady gain in weight is es- 
tablished the surrounding temperature may be re- 
duced very gradually under a continuous control of 
the baby's weight and temperature; abrupt changes 
must be avoided most sedulously. 

The thoughtful tender care and unrelaxing watch- 
fulness required by these cases is possessed by only 
a few women, and the writer has observed that the 
success in rearing these cases is largely due to the 
personality of the nurse, some of whom will be able 
to carry cases through to unexpected results, where 
other nurses, even those most experienced in their 
work in general, would most probably have failed. 

Human milk is the only proper food for these 
cases, but as the premature infant is usually too 
weak to draw this itself, the breasts must be pumped 
mechanically, and they would soon dry up owing to 
the lack of the normal stimulation of the sucking in- 
fant, no matter how careful and how regular we are 
in pumping the breasts. The most universally suc- 
cessful plan is to put a healthy, strong and well- 
nursing baby to the breasts of the mother of the pre- 
mature infant and to give the latter some of the 
milk expressed after the healthy infant has nursed, 
because this milk contains more fat and therefore 
more energy in smaller amounts ; we also know from 



120 THE CHILD IN HEALTH AND ILLNESS 

experience that the premature infant can digest this 
comparatively rich food very well. 

It is frequently quite difficult to make these in- 
fants take any food at all, and in many cases we will 
succeed best by giving it drop by drop with a medi- 
cine dropper or Breck feeder (see Fig. 39). Here 
again experience with these cases counts for a great 
deal. 

Another difficulty in rearing these infants con- 
sists in preventing complications from the lungs 
due to the insufficient breathing. This can frequent- 
ly be accomplished by making the children cry by 
shaking them rather strongly or even pinching them 
if necessary; if this should not succeed we have to 
resort to cold showers given while the child is in a 
warm bath ; needless to say that this procedure must 
be done so as to avoid chilling the infant, and to do 
this will tax to the utmost the skill of a very ex- 
perienced nurse. 

A grave problem is also how to guard these babies 
against the invasion of germs, because they have not 
the least resistance against these, and even the 
slightest infection may cause a severe, perhaps a fa- 
tal, illness. A cold in the head contracted from a 
slight cold of the nurse or a casual visitor may 
cause an inflammation of the lung or the ear fol- 
lowed by general blood-poisoning; therefore in or- 
der to succeed in these cases it is essential to keep all 
visitors away from these babies, and if the nurse or 
the mother should be so unfortunate as to contract 
a cold, they should wear a gauze mask (see Fig. 40) 



THE PREMATURE INFANT 121 

whenever they come close to the infant. Infection of 
the navel in these cases means certain death. The 
old-fashioned and superfluous practice of wiping out 
the baby's mouth may, and will most likely, lead to 
injuries of the lining of the mouth and it may thus 
open the road to a general infection. 

Needless to say that even after the infant has 
been safely steered past these dangers and has been 
carried through the first weeks of life by constant 
care and watchfulness, it will remain backward and 
be like a tender hot-house plant for some time, 
though later in life it will not suffer from any handi- 
cap by reason of its having been born prematurely. 



CHAPTER IX 
THE DISEASES OF INFANCY 

WE have seen that the most frequent diseases 
of infancy are those due to digestive disturb- 
ances, but other diseases are liable to attack the 
young child, and the mother should be somewhat 
familiar with these, so as to be able to recognise 
them early enough to seek the physician's advice. 

Constipation. This frequent trouble is usually 
due to overfeeding and the consequent relaxation 
of the overtaxed and tired intestine. The pernicious 
habit of treating this condition by laxative medi- 
cines or by the rectal application of suppositories or 
by bowel-washes can not be too strongly condemned, 
not only because one can readily imagine the baneful 
effect of the habitual use of drugs in infants, but 
also because the use of any of these measures allows 
the condition to become worse, instead of the phy- 
sician's getting at the root of the evil and attacking 
its cause. 

Sometimes constipation may also be due to starva- 
tion or to the fact that the food is too concentrated 
and that the baby is not given enough water. 

In other cases again it may be due to local condi- 
tions in the lower bowel, or careful examination may 

122 



THE DISEASES OF INFANCY 123 

reveal a small crack in the lining of the lower bowel 
where it joins the skin, a so-called fissure; in which 
condition the passage of the stools causes consider- 
able pain so that the baby is afraid of its passage 
and holds it back. These cases are not difficult to 
recognise. The infant cries with pain when it passes 
its stool, while it is otherwise normal. The phy- 
sician is able to heal this in comparatively little time. 

Diarrhoea. This is in the beginning nature's own 
help to rid the intestine of irritating material and 
it is always the consequence of bad feeding or of 
an infection. It would be wrong to stop it at once 
by administering constipating drugs; much better 
would it be to aid nature in its good intent by the 
administration of castor oil, the only physic fit to be 
given to infants and children. 

Should the emptying of the bowels not stop the 
diarhcea, then the physician must be called before 
an inflammation of the lining of the intestine de- 
velops. 

Inflammation of the lining of the mouth is fre- 
quently due to the pernicious as well as superfluous 
habit of wiping out the infant's mouth, which is still 
practised as an outgrowth of mistaken and exagger- 
ated ideas of antisepsis. Sharp-edged toys, whose 
cleanliness is not always above suspicion, and the 
dirty pacifiers are another frequent source of these 
infections, which at times may eat so deeply into the 
tender tissues as to destroy some of the teeth in their 
formation. 

Thrush or white-mouth is caused by the growth of 



i2 4 THE CHILD IN HEALTH AND ILLNESS 

a certain fungus in the mouth, where it forms larger 
or smaller white spots. At times the whole mouth 
may be covered by these ; it is only found in infants 
who are fed badly and are therefore suffering from 
some digestive disturbance. Its presence in the 
mouth of an apparently healthy baby should make 
the mother call in the physician, who will find that a 
change in the child's diet is indicated. As soon as 
the digestion has been improved it will be easy to 
cure the thrush. 

Should the unboiled milk from cattle suffering 
from hoof and mouth disease be given to children, 
then they will suffer from a severe inflammation of 
the mouth, the so-called stomatitis aphthosa. Since 
we boil the milk in all cases this disease is no longer 
observed by us. 

Grippe. Corresponding to the increased mortal- 
ity among infants in summer we will also observe a 
similar increase of the deaths among infants under 
one year of life in winter. This is due to the increase 
of the diseases of the respiratory tract during this 
season, and it is caused by an infection with the 
grippe germs, which is very readily transmitted 
from one person to the other and to which children 
are extremelv sensitive. 

Formerly we used to consider this infection to be 
' ' a cold, 9 ' and thought that it came from drafts and 
wet feet, but lately we have learned that it is noth- 
ing else but a very infectious disease, which at the 
same time is the more dangerous the younger the 
patient. 



THE DISEASES OF INFANCY 125 

In children's hospitals and orphan asylums we 
can observe how a physician or a nurse suffering 
from a coryza, a so-called "cold in the head," will 
infect many children, who in their turn again will 
infect every child in this ward, and this while the 
babies are most carefully guarded against all kinds 
of draft and chilling; we can, on the other hand, 
keep these same infants free from this infection if 
we only protect them against each other by gauze 
screens and by making any doctor or nurse or vis- 
itor who has a coryza wear a gauze mask in front 
of their mouth and nose whenever they come near 
the infants. 

In private families we can always trace this in- 
fection to some inconsiderate visitor who approaches 
the babv and even kisses it while he is himself in- 
fected, or to the other children in the family or the 
parents or servants. One such infection will usually 
go through the w r hole household and the poor baby 
is the one who has to suffer the most from it. 

If we want to protect infants from grippe and its 
dangerous complications we must be firm in keep- 
ing visitors aw r ay from them, no matter how much 
they may object to what they call new-fangled no- 
tions, and we must never allow anybody to kiss a 
baby, especially on the mouth. Even the fond 
mother would be kinder to her little one if she made 
it a rule to kiss her child on the cheeks or forehead 
but never on the mouth. 

The usual beginning of a grippe is a coryza or a 
rhinitis, commonly called a ' ' cold in the head.' ' The 



126 THE CHILD IN HEALTH AND ILLNESS 

child sneezes ; it is restless and bad-tempered ; sleep 
and feeding are interfered with owing to the swell- 
ing in the anterior part of the nose, because infants 
have not yet acquired the pernicious habit of breath- 
ing through the mouth, which, by the way, was con- 
sidered the height of impoliteness among our Ameri- 
can Indians, who despised a person who "breathed 
like a dog." Fever is present as a rule but it is 
moderate. The next day, when the nose begins to 
run, will usually bring some relief. 

In some cases the infection will not be confined to 
the anterior part of the nose only, but it will go back 
where the nose joins the mouth. The whole cavity 
of the nose will be infected, whence the infection will 
spread over the rear wall of the nose and mouth, 
the soft palate and the tonsils ; these parts will be 
red on inspection ; the glands in the neck and those 
under the jaw will be swollen. 

If the infection should go still farther down it will 
cause a swelling in the throat and the windpipe, and 
we will now observe the terrifying picture of a con- 
dition which is, however, not at all dangerous, the 
so-called spasmodic croup or pseudo-croup. A child 
which has been suffering from a coryza goes to bed 
in apparent good health to wake up suddenly dur- 
ing the fore part of the night with the symptoms of 
suffocation and a loud barking cough, which reminds 
one very much of whooping cough, though it is con- 
tinuous ; the child may get some relief after vomit- 
ing. After the attack has been relieved by some 
simple measure, such as the inhalation of steam or 



THE DISEASES OF INFANCY 127 

a wet compress around the throat, the child will go 
to sleep again. 

These attacks of pseudo-croup will get the whole 
family out of bed and the physician will be called 
in a great hurry. Some children and some families 
seem to be more disposed toward it than others. 
An experienced physician will often be able to pre- 
dict the occurrence of such an attack and he will be 
able to advise the necessary procedures beforehand, 
even though he can not always prevent their occur- 
rence. 

Should the infection go still further down in the 
respiratory tract it will cause a bronchitis and even 
a pneumonia, one of the most dangerous diseases of 
infancy, especially for bottle-babies, whose diges- 
tion will always be seriously interfered with. 

Thus we will see that even a so-called "slight 
cold" is always to be considered a serious matter in 
a young child and requires careful attention, be- 
cause thus only may we be able to prevent the more 
serious complications, and that not always. 

The infection of grippe may ascend from the 
posterior part of the nose through passages, which 
are relatively wide in infants, into the middle ear 
and may here cause a serious inflammation. 

This is of very frequent occurrence in infants. 
They will be feverish and cry a great deal and if 
the physician is not called at once the explanation 
of the child 's illness will be found, after a delay of 
some days and considerable needless suffering on 
the part of the baby, in a discharge from one or both 



128 THE CHILD IN HEALTH AND ILLNESS 

ears, which will require very careful and long-con- 
tinued treatment to save the child from permanent 
deafness or impaired hearing. 

In this connection we may state that the old bar- 
barous fashion of piercing the lobes of the ears of 
little girls, though it is dying out to some extent, is 
still practised, and that this frequently leads to in- 
fections which may extend to the inner ear. 

The irritation of the skin around the lower open- 
ing of the bowel, the anus, and on the buttocks is due 
to the condition of the urine and the stools and it is 
found usually in infants with diarrhoea ; great care 
on the part of the mother or nurse and frequent 
changing of the napkin will almost always prevent 
this. Once it has started it will be cured only when 
the digestion is normal once more. 

The development of boils is favoured by the low- 
ered vitality due to digestive disturbances and the 
consequent diminished resistance to infection; it is 
therefore almost exclusively observed in bottle-ba- 
bies, and of these those who are overfed with 
starches furnish the greatest number. Lack of 
cleanliness is a contributory cause. 

The size of the single infected spots may vary con- 
siderably ; it may be no larger than a cherry-pit, or 
it may form tremendous abscesses covering or un- 
dermining at times the larger part of the back or 
the scalp. 

In these cases we should give breast-milk when- 
ever this is possible, partly because it will repair 
the digestive disorder sooner than any other food, 



THE DISEASES OF INFANCY 129 

and partly because it confers some resistance to the 
germs which will be noticed even before the human 
milk has improved the alimentary condition. 

Tuberculosis. That tuberculosis is a frequent dis- 
ease in infancy and that it is also a very dangerous 
infection at that age is shown by the fact that twice 
as many children die during the first two years from 
this disease than do people of from fifteen to thirty 
years. Of the children under one year who are in- 
fected wifh the germ of tuberculosis none will sur- 
vive. 

The infection is usually carried by the mother or 
nurse who has, what is called, an open consumption, 
that means she ejects tubercle bacilli not only when 
she coughs but also when she talks. Through the 
close proximity, especially of the nursing mother, 
infection may and will take place very readily. It 
is however not necessary to have a tuberculous per- 
son in constant close contact with a baby in order 
that this should become infected; many a case has 
been traced to a single short visit of some tubercu- 
lous person or a kiss from an infected relative. 

Later when the baby begins to creep around on 
the floor or when it has frequent falls, in its early 
attempts at walking, it is exposed to the infection 
from the dried expectoration of perhaps some for- 
mer inhabitant of the dwelling whose habits of clean- 
liness were not above reproach, and who was there- 
fore not careful about the disposal of his sputum. 

People are very careless in moving into houses 
which have been occupied before, especially when 



130 THE CHILD IN HEALTH AND ILLNESS 

the floors are of soft wood with cracks between th< 
boards, which form a favourable receptacle for dried] 
expectorations in which the tubercle bacillus can pre- 
serve its vitality for a long time. 

The creeping infant is then frequently exposed to 
this dust, which can not be removed even by the 
most careful methods of ordinary house-cleaning, 
and it will inhale the germs. These will either settle 
in the lungs or in the glands in the chest, or the baby 
may injure itself in one of its frequent falls and this 
injured part will form a good place for the growth 
of the germs which are circulating in the system, 
and thus will cause now or later a tuberculosis of a 
bone or joint. 

The writer is certain that the very low little sul- 
kies and carts which are so much in use now are also 
dangerous in this respect, because they bring the 
children into close proximity to the street-dust which 
is notoriously dangerous in this country where ex- 
pectoration is not yet recognised as one of the filth- 
iest as well as a most unsanitary habit. 

Syphilis. This is a very dangerous inherited dis- 
ease. It may also be transferred by the wet-nurse 
and by close contact with infected people, or when 
the baby is allowed to place some article in its mouth 
which had been in the mouth of an infected person. 

One of the earliest and most characteristic signs 
of the disease in infants is a peculiar sawing noise 
produced when the air goes through the narrowed 
nostrils. All kinds of skin-eruptions, principally on 
the palms of the hands and the soles of the feet, and 




Figure 40. gauze mask 





Figure 41. eczema cuff 



Figure 42. eczema cuff applied 



THE DISEASES OF INFANCY 131 

also inflammations around the nails and the lips are 
frequently observed. 

These infants, when born alive, frequently remain 
weakly and do not thrive. They are greatly in need 
of human milk and they must therefore be nursed by 
their mothers, who, for obvious reasons, will not be 
infected by them; they must never be given to a 
wet-nurse, whom they will be almost sure to infect, 
but if the mother has no nourishment for them they 
should be given breast-milk from the bottle. 

Every case of this kind demands early and long- 
continued treatment and medical supervision for 
years ; thus only will we succeed in overcoming the 
inherited taint and its consequences. 

Neglected cases and those which are not recog- 
nised in time are the ones in which the disease will 
manifest itself at some later age ; these are the un- 
fortunates who populate our institutions for the 
blind, the deaf and dumb, and the defectives. 

Rickets. Eachitis is a constitutional disorder 
which appears usually during the second half of the 
first year of life and the principal signs of which 
are found in the bones. 

These babies either learn to sit up or walk rather 
late, or they may give this up after they have been 
able to do so ; the large fontanel will be open much 
past the first year of life and it will remain wide; 
the joints, especially the wrists and ankles, are 
thickened and set off. At the juncture of the bony 
ribs and the cartilages we find bead-shaped thicken- 
ings which form together the so-called rachitic ro- 



132 THE CHILD IN HEALTH AND ILLNESS 

sary; the skull, especially the back part of it, be- 
comes soft, and the children perspire very freely 
over this part of the head; this in turn leads to their 
rubbing their head on the pillow and thus the hair is 
worn off. The traction of the diaphragm on the soft 
lower ribs may draw these inward and thus interfere 
with the full expansion of the lungs. 

If these babies who are suffering from the severer 
grades of rickets are permitted to walk they will 
become bow-legged or if they are carried around on 
the same arm always, they w T ill have deformities of 
the spine, at times of the severest grades. 

The cause of rachitis may be summed up in a few 
words ; it is due to ignorance or neglect or a combi- 
nation of both,- hereditary disposition seems to play 
a material part in its occurrence, especially among 
coloured and Italian babies, but we know from a 
large experience with numerous children in the same 
families, that this hereditary disposition can be 
overcome quite easily by the proper precautions. 
Kickets is the consequence of bad feeding, even at 
the breast, lack of fresh pure air and insufficient or 
wrong care. The bad feeding may be found in 
breast-babies who are overfed and who are kept at 
the breast exclusively for too long a time ; in bottle- 
babies the feeding may be one-sided or overfeeding 
may be practised. The effect of bad air can be ob- 
served principally during the winter months, when 
the infants are kept in the close atmosphere of the 
dwelling and are but rarely taken out for an airing. 
The poor care consists in the too rare changing of 



THE DISEASES OF INFANCY 133 

the infants, in consequence of which the air around 
these children is continuously overcharged with the 
ammonia from the disintegrating urine in the dia- 
pers and in the bedding, and the poor infant has to 
inhale this all the time. In the practice among the 
poorer classes the physician can frequently tell that 
a baby will be found to have rickets when he per- 
ceives the peculiar ammoniacal odour on approach- 
ing his little patient's bed-side. 

Babies with rickets cry a great deal owing to the 
pains they suffer in their bones, especially when they 
are handled, they demand a considerable amount of 
care to prevent the various forms of deformities 
wdiich in later years will lead the child into the hands 
of the orthopedist in still far too many instances. 

Eachitis is a disease which can be easily pre- 
vented, at least to some extent, by proper hygiene 
and which, when taken under treatment in the very 
beginning, can be cured readily; every severe case 
of this disease, as we see them so frequently on the 
streets, is a damaging testimony of somebody's ig- 
norance or neglect. 

Infantile Scurvy. This is another disease which 
is caused by bad feeding. It is found exclusively in 
bottle-babies ; it requires a special disposition of the 
infant and it usually appears between the sixth 
and eighteenth month of life. It is frequently asso- 
ciated with rickets. 

The symptoms of scurvy are severe anemia, swell- 
ing on the bones and severe pains on motion and 
when the child is taken up, bleeding and swelling of 



M^M 



134 THE CHILD IN HEALTH AND ILLNESS 

the gums, but this only when the child has some of 
his teeth or when they are just coming through, and 
then around the teeth only. Bloody urine and bleed- 
ing into the skin may also be observed. 

Most of these cases respond very quickly to a 
proper regulation of the diet when the physician has 
been consulted in time. The early administration of 
orange juice and of vegetables to babies is a sure 
preventative. 

Lymphatism. Of late a peculiar constitutional 
condition has been recognised which predisposes to 
swelling of the lymphatic apparatus, and we begin 
to understand the relation of this condition to some 
abnormal symptoms in children w 7 hich we were for- 
merly unable to explain. 

These children are subject to enlargement of the 
glands, which in later years may lead to adenoids 
and enlarged tonsils, and also to appendicitis ; they 
are very little resistant to grippy infections and 
have frequent attacks of bronchitis, also, by no 
means rarely, asthma. Their w T hole body is water- 
logged, and when they get eczema this is usually of 
the moist, weeping type ; w 7 hen exposed to an infec- 
tion with the tubercle bacillus they are a ready prey 
to its ravages. 

This constitutional condition is an inherited one 
and we often hear that one or more members of the 
immediate family are suffering from some chronic 
complaint, not rarely asthma. 

The inherited tendency to this constitutional dis- 



THE DISEASES OF INFANCY 135 

position can be overcome by careful regulation of the 
diet and by hygienic living. 

Convulsions in infants are due to a nervous hy- 
perexcitability and are most frequently due to over- 
feeding, especially with cows' milk, and they appear 
mostly at the end of winter. They may be either 
general, a condition which is sure to frighten the 
mother, or they may affect only the throat, the so- 
called staying away or internal convulsions, or they 
may also be observed in the extremities only. Some 
children get convulsions every time they are sick. 

The best remedies for this condition are careful 
hygiene and proper regulation of the diet; young 
children should be given breast-milk ; in older ones 
large amounts of animal food should be avoided. 

During the general convulsion nothing is better 
for the little patient than absolute rest, which is 
preferable to the excitement and bustling activity 
usually prevailing. It is of the greatest importance 
to keep out solicitous friends and neighbours with 
their well-meant but unsolicited and more or less 
phantastic advice. Naturally the physician must be 
called at once. 

Eczema. In most infants we find an increased 
secretion from the fat-producing glands in the scalp, 
and to a lesser degree in the eye-brows. If this se- 
cretion on the scalp is allowed to remain, the forma- 
tion of thick yellow scales will take place and later 
that of crusts ; under these the scalp will at first re- 
main normal or show only a slight reddening, but 
ere long we will be able to observe how the skin 



136 THE CHILD IN HEALTH AND ILLNESS 

under these crusts contains small swellings which 
will soon form little blisters and we now have the 
picture of eczema. This will spread over the face 
and behind the ears and also in the neck. In some 
cases the trouble may also start in the face or be- 
hind the ears, where we notice redness and rough- 
ness of the skin, which will sooner or later change 
into eczema, if it is not treated at once. 

The disposition to eczema is undoubtedly inherit- 
ed, and we see it most frequently in fat babies; 
breast-babies are quite as liable to this disorder as 
are those brought up on the bottle. Still, feeding has 
a great deal to do with the production of eczema ; al- 
most invariably we will find that the infant was over- 
fed. On the other hand we can observe how an ex- 
isting eczema heals when the infant is suffering 
from some acute disease, as pneumonia, to reap- 
pear when the child is well again. 

The fully developed eczema which may cover the 
entire scalp, the face and other parts of the body is 
one of the most obstinate diseases to treat, and the 
poor infants who suffer a great deal from the itch- 
ing and who therefore want to dig their nails into 
their skin require a great amount of care. 

The scratching which exposes the child to infec- 
tions of the skin must be prevented at all cost. This 
can be done best by taking some old corset stays, 
cutting these down to the required length and sew- 
ing them between two layers of strong cloth and 
providing this with tape to tie around the child's 
arms (see Fig. 41) so that it can no longer bend its 



THE DISEASES OF INFANCY 137 

arm at the elbow and thus reach the itching spots 
(see Fig. 42). This is the simplest, safest and at the 
same time the most humane method of preventing 

the dangerous scratching. These cuffs can be easily 
made and are washable. 

Prevention is of the utmost importance in eczema. 
The scabs or crusts on the scalp should be removed 
daily after the bath; if they should not be easily re- 
movable or if they should have been allowed to be- 
come rather extensive, a layer of absorbent cotton 
should be soaked with olive oil or sweet-almond oil 
and applied in the evening; over this should be 
placed a piece of oil-silk and the whole should be 
kept in place by a cap ; next morning the scalp can 
be cleaned easily. 

The treatment of eczema should always be in the 
hands of the children's specialist who is familiar 
with the effect of diet, by which alone quite a num- 
ber of these cases may be cured. If the eczema 
should be very extensive and of long duration he may 
call in his friend the skin-specialist for suggestions 
as to the local treatment, but he should always keep 
the case under his own supervision. 



CHAPTER X 



THE DEVELOPMENT OF THE CHILD 



WITH the time of weaning and the eruption of 
the teeth the infant passes into the stage of 
childhood, which in its turn lasts until the period of 
puberty, the time when the children mature. AVe 
will therefore see that childhood extends from the 
end of the first year of life to about the end of the 
fifteenth year. 

The growth during childhood, while not as rapid 
as during infancy, is quite regular as shown in the 



following 


table 


; 














BOYS 








GIRLS 




Wght, 


Hght., 


Chest, Head, 


Age 


Wght, 


Hght, 


Chest, 


Head, 


in lbs. 


Ins. 


Ins. 


Ins. 




in lbs. 


Ins. 


Ins. 


Ins. 


7.5 


20.6 


13.4 


13.9 


Birth 


7.2 


20.5 


13.0 


13.5 


16.0 


25.4 


16.5 


17.0 


6 mos. 


15.5 


25.0 


16.1 


16.6 


20.5 


29.0 


18.0 


18.0 


12 mos. 


19.8 


28.7 


17.4 


17.6 


22.8 


30.0 


18.5 


18.5 


18 mos. 


22.0 


29.7 


18.0 


18.0 


26.5 


32.5 


19.0 


18.9 


2 yrs. 


25.5 


32.5 


18.5 


18.6 


31.2 


35.0 


20.1 


19.3 


3 yrs. 


30.0 


35.0 


19.8 


19.0 


35.0 


3S.0 


20.7 


19.7 


4 yrs. 


34.0 


38.0 


20.5 


19.5 


41.2 


41.7 


21.5 


20.5 


5 yrs. 


39.8 


41.4 


21.0 


20.2 


45.1 


44.1 


23.2 




6 yrs. 


43.8 


43.6 


22.8 




49.5 


46.2 


23.7 




7 vrs. 


48.0 


45.9 


23.3 




54.5 


48.2 


24.4 




8 yrs. 


52.9 


48.0 


23.8 




60.0 


50.1 


25.1 




9 vrs. 


57.5 


49.6 


24.5 




66.6 


52.2 


25.8 


21.0 


10 vrs. 


64.1 


51.8 


24.7 


20.7 


72.4 


54.0 


26.4 




11 yrs. 


70.3 


53.8 


25.8 




79.8 


55.8 


27.0 




12 vrs. 


81.4 


57.1 


26.8 




88.3 


58.2 


27.7 




13 yrs. 


91.2 


58.7 


28.0 




99.3 


61.0 


28.8 




14 yrs. 


100.3 


60.3 


29.2 




110.8 


63.0 


30.0 


21.8 


15 yrs. 


108.4 


61.4 


80.3 


21.5 


123.7 


65.6 


31.2 




16 yrs. 


113.0 


61.7 


30.8 





138 



THE DEVELOPMENT OF THE CHILD 139 

A remarkable fact which has been indicated in the 
above table by italics is this, that between the ages 
of twelve and fourteen years girls grow faster than 
boys and are at the same time heavier as well as 
taller; after this age the boys outstrip the girls 
again. 

The second dentition takes place from the sixth 
year on. First appear the four permanent molars, 
usually between the fifth and seventh year, then 
the milk-teeth are replaced by the permanent teeth, 
and finally the second molars come through about 
the time puberty will be established; the third mo- 
lars or w T isclom-teeth come still later : 



XVI— 


XII] 


r 






to 






-XVI 


-XXVI 






XTT- 










-XV 














XT 








XIII 


















■v 


















TV 






VII 

22 


26 








V — 

21 




VIII 


6 




29 


25 


17 


9 


13 


5 


3 4 


14 


10 


18 


30 


31 


27 


23 


19 


11 


15 


7 


1 2 


8 


16 


12 


20 


24 


28 


32 



Little more need be said about the further devel- 
opment of the child, mental as well as physical ; with 
the proper care it will go on in its even tenor ; with- 
out this it will frequently be interrupted by attacks 
of sickness which are not severe enough to be digni- 
fied by the name of a 'disease, but the frequency of 
which will, in, alas, too many instances, leave the 
child inferior in some way. 

The better the child is looked after and the more 
carefully it is fed, the easier will it, as a rule, over- 
come the so-called children's diseases, which are 



140 THE CHILD IN HEALTH AND ILLNESS 

really nothing else than diseases which are always 
present in a community and w T hich in consequence 
few will escape during childhood ; whenever one of 
these diseases strikes a population where it has not 
appeared before, it will attack everybody, regardless 
of age, and it will therefore then appear as an epi- 
demic disease. Few remember that comparatively 
few years ago smallpox w T as regarded as a children's 
disease and was quite as common as measles for in- 
stance. 

With school-age w T e get the additional danger of 
these infectious diseases owing to the close contact 
into which the large number of children are brought 
daily, but we find then other disorders as w T ell which 
are due to unhygienic conditions in the school, which 
are still far too prevalent, though much is being done 
in this line in our larger communities; in the rural 
communities school-buildings and school-hygiene 
still leave much to be desired as a rule. 

When the children go to school they are usually 
not so carefully guarded any longer, and this also 
has its dangers. 

On the other hand the children of the wealthy w T ho 
are taught in their own homes for fear of catching 
diseases and whose recreation consists mainly in 
walks or rides in the park with a governess, are to 
be pitied; they may be likened to some rare hot- 
house flower which looks beautiful but tender and 
sickly and which can not stand our bracing climate. 

Healthy children, or better children in order to be 
healthy, require the right proportion of both free- 



THE DEVELOPMENT OF THE CHILD 141 

dom and restraint ; they have to come in contact with 
the outer world, rough though it may be at times, in 
order to develop into real men and women who will 
be able to stand up in this continuous struggle for 
the survival of the fittest ; but who will at the same 
time have an understanding as well as a heart for 
those less fortunately endowed by providence than 
they were themselves. 

Most to be pitied in the writer's opinion are the 
only children in wealthy families. Lacking the com- 
panionship of those of their own age, they are 
thrown too much into the company of adults, with 
the consequence that they adopt the opinions of their 
elders and imitate their ways, with the result that 
they are nothing more than prematurely grown up 
little men and women, who in later years will surely 
feel that they have missed their youth. Moreover, 
owing to the constant exaggerated care of an over- 
anxious mother, or by their association with hired 
menials to whom this duty has been delegated, they 
are kept away from every danger, so that they will 
later lack confidence in themselves and will only too 
often fall by the wayside, because they have not been 
taught to overcome temptation when they were 
young. 

What more beautiful than to see brothers and 
sisters romping around in the open air, regardless 
of the weather, developing health and strength of 
body and mind in the competition of play; what 
more pitiful on the other hand than the only child 
looking on in envy and longing ! 



CHAPTER XI 
THE FEEDING OF CHILDREN 

WHEN the child is being weaned, it changes 
from a lactivorous organism which is living, 
at least when it gets the food destined for it by na- 
ture, namely human milk, on a food which has ex- 
actly the right proportions of all its constituents in 
the shape in which it can be the easiest digested, to 
the omnivorous organism which man represents, liv- 
ing on material which demands considerable work 
from the system before it can be digested. 

We have to consider now what the demands of the 
child's body for food will be at this time. 

First of all we must have a clear understanding 
of the fact that there is a vast difference between 
the demand of a child for food and its consumption 
of food. As is only too well known to the physician, 
children at this period of life are very frequently 
overfed. Few mothers know how much their baby 
had been receiving at the breast and when she weans 
it she attributes every crying spell to hunger, and in 
giving more food she adds to her mistake ; thus only 
can we explain the large number of cases of diges- 
tive disturbances at this time. 

Whenever possible the physician should superin- 

142 



THE FEEDING OF CHILDREN 143 

tend the weaning and lie should determine by care- 
In] weighing, both of the infant and of the food, how 
much the child is getting and what progress it is 
making. 

What then are the demands of the young child 
for food? 

The answer to this question can not be given off- 
hand, but must be given separately for each age 
and weight of the children. 

Digestion, assimilation and the demand for food 
correspond to the relative surface of the body, but 
there is no material difference in the assimilation of 
the adult and that of the child, except as far as the 
fact is concerned that the one is growing and the 
other is not. 

The child lives almost exclusively on fat and car- 
bohydrates, that is sugar and starches, from which 
it produces the necessary heat; it reserves the pro- 
tein, the albumen in the food, for growth and it will 
therefore be able to get along with relatively small 
amounts of protein in its food, about one-tenth of its 
daily allowance. 

A safe rule to remember is the following : 

The proportion of the fats to the carbohydrates 
should be such a one that the child's food contain 
six to seven parts of carbohydrates by weight to one 
part of fat. 

As to the salts in the food, some of this is a nec- 
essary addition, but the child should not get more 
than one grain of table-salt per pound of body- 



144 THE CHILD IN HEALTH AND ILLNESS 

weight daily, as every additional grain of salt has to 
be gotten rid of and thus creates a demand for more 
water ; an excess of water in its turn will carry aw 7 ay, 
not only the superfluous common salt, the sodium 
chloride, but other salts as w r ell which were not in 
excess in the food and which will thus be lost to the 
body. 

After these general remarks the natural question 
will be : AVhat shall we give the young children to 
eat and how shall we give it ? 

At the time of weaning it is best to adhere to the 
well-tried five feedings daily at four hour intervals, 
nothing naturally being given at night ; but as soon 
as possible we should leave out the afternoon meal, 
the one corresponding to the afternoon tea, and later 
also the second breakfast, so that the child, when it 
is two years old, will receive one-quarter each of its 
daily allowance at breakfast and supper, and one- 
half at dinner, the heaviest meal coming always in 
the middle of the day, followed by a nap. 

Some children may have to continue on four or 
five meals a day for some time longer on the phy- 
sician's advice, but most children will have a much 
better appetite and will thrive much better on three 
square meals a day, even at from two to three years 
of age. We must, however, not attempt to deceive 
ourselves ; we must call everything given to eat and 
every glass of milk a meal. 

The caloric demands of the child, after the second 
year of life, are twenty-five to thirty calories for 
each pound of body weight. The food should then 



THE FEEDING OF CHILDREN 14S 

be so composed that of each one hundred calories 
proteid should furnish ten calories, fat thirty cal- 
ories, and carbohydrate the remaining sixty calories. 

The caloric value and composition of different 
dishes will be shown on pages 148 and 149. 

In what form should we then give the necessary 
food at this time? 

We must, first of all, get away from the old idea 
which is still too deeply rooted in the minds of the 
laity as well as of many physicians, that milk, ani- 
mal milk, is the ideal food for children after the com- 
pletion of their first year of life. It is a poor enough 
substitute for mother's milk during infancy. Why 
then should we wean a child from the mother's 
breast to give it another food destined for infants, 
infant cows though they be? Does not the develop- 
ment of the teeth at this time clearly indicate the 
nature of the food to be given forthwith? 

Many an originally healthy set of teeth is spoiled 
through lack of use at this early age and by the con- 
tinued feeding with liquid of semi-solid food. The 
solidity of the food should be determined by the 
stage of eruption and the number of the teeth. 

Broth, which used to be considered one of the 
mainstays in the bringing up of young children, 
makes a good recipient for farinaceous food-stuffs, 
but it should not be given by itself, for it is too vo- 
luminous in proportion to its slight nutritive quali- 
ties ; it is also too rich in salts, containing about one 
and one-half parts in one hundred parts ; its value as 



146 THE CHILD IN HEALTH AND ILLNESS 

a food is therefore determined by what we cook in 
it. Strong broth and beef-tea are stimulants and as 
such have no more place in the dietary of the healthy 
child than has alcohol. 

During the second year of life when milk is still 
given in considerable quantities, this will furnish 
most of the proteins, some of which will also be sup- 
plied in the cereals. The salts will be provided in 
the tender young vegetables and in the fruit. Of 
the vegetables the best for this age are spinach, let- 
tuce, carrots, potatoes, and Spanish chestnuts; of 
the fruits, apples, pears, oranges and bananas, these 
latter only cooked either as a vegetable or as fruit. 
Exceedingly valuable are also the Leguminosae: 
dried beans, peas, lentils and soy-beans. 

As the young vegetables are given principally for 
their salts, especially the iron, — a cup of cooked 
spinach, for instance, contains enough iron to supply 
the needs of a child for a whole week — we must see 
to it that the child really receives these ; in the ordi- 
nary household the water in which the vegetables 
have been boiled is thrown away, and as this con- 
tains most of the salts, the child is thus deprived of 
a most essential part of its food. This water must 
therefore be boiled down and added again to the 
vegetables when they are strained. 

For the teeth nothing is better than to give the 
child dry toast made in the oven (not the soggy 
kind), zwieback, Holland rusk, crackers and graham 
wafers. 



THE FEEDING OF CHILDREN 147 

During the next two years we may give occasion- 
ally, but by no means regularly, an egg or some 
minced meat; we can also allow the coarser vege- 
tables, such as the different kinds of cabbages, cauli- 
flower, parsnips, turnips and asparagus; of the 
fruits those with pits and the berries with the seeds 
strained out, except strawberries ; the child may now 
be given bread, ordinary toast and rolls. 

After the age of four the child may eat at the 
family-table, especially as it may now be allowed to 
chew its meat, and it is safer that it do this under 
the watchful eye of its parents, as it might, other- 
wise, acquire the pernicious habit of bolting its food \ 
it may be given all kinds of vegetables and fruits, 
and the daily allowance of milk should be cut down 
still further, though this will hardly be necessary, 
as many children refuse to drink milk at this age. 

The child may and should partake of the regular 
meals of the family. It must know, however, that it 
can not have of everything that is brought to the 
table, and it should not be given of this or that of 
which it may not have a full helping. 

We have seen before that the older child should 
have from twenty-five to thirty calories for each 
pound of its weight, and that the food should be so 
chosen that of each one hundred calories furnished 
to the child ten calories should be given as proteids, 
thirty as fat and the remaining sixty calories as 
carbohydrates, that is as sugars and starches. 

In the following table are given portions of pre- 



148 THE CHILD IN HEALTH AND ILLNESS 

pared foods representing one hundred calories each; 
in it is also shown by what these calories are repre- 
sented, so that it will be comparatively easy to tell 
from this what quantities of each article of diet 
should be given to the child and how one may ar- 
range the daily menu. 

The figures in this table are only approximate and 
they are rounded off for the sake of convenience; 
they are, however, sufficiently correct for the pur- 
pose for which they are intended. 



Food Amount 



Whole milk 5 oz. 

Skim milk 10 oz. 

Cream 2 oz. 

Buttermilk 10 oz. 

Whey 13 oz. 

Curds 2 oz. 

Skim-milk cheese 1% oz. 

Cream cheese % oz. 

Butter Y-2 oz. 

Olive oil Vn oz. 

Egg 1 large 

Scrambled eggs 1% oz. 

Meat broth 3 pints 

Boiled beef 1% oz. 

Roast beef or chop 1% oz. 

Roast pork % oz. 

Roast lamb 1% oz. 

Roast veal or chicken 2 oz. 

Boiled chicken 2 oz. 

Boiled fish 3 oz. 

Salted fish iy 3 oz. 

Smoked fiss 1% oz. 

Ham % oz. 

Lean bacon % oz. 

Potato 1 medium 

Bread 1 slice 

Zw ieback 1 

Cocoa 3 teaspoon!" uls 

Cooked cereal 1 cup 

Rice boiled in water 12 oz. 



Proteid 


Fat Carbohydr 


Calories 




20 


50 


30 


40 


10 


50 


10 


80 


10 


40 


10 


50 


10 


10 


80 


25 


70 


5 


75 


25 


— 


30 


70 


— 


— 


100 


— 


— 


100 


— 


30 


70 


— 


25 


75 


— 


30 


70 


— 


40 


60 


— 


65 


35 


— 


20 


80 


— 


50 


50 


— 


70 


30 


— 


75 


25 


— 


90 


10 


— 


30 


70 


— 


50 


50 


— 


25 


75 


— 


10 


90 


— 


5 


15 


80 


15 


5 


80 


10 


5 


85 


15 


30 


55 


10 


15 


75 


10 


15 


75 



THE FEEDING OF CHILDREN 



149 



Food 



Amount 



Rice boiled in milk 4 oz. 

Farina boiled in water 9 oz. 

Farina boiled in milk 3 oz. 

Pea or bean soup M> cup 

Thiek pea soup or white beans. % cup 

Green peas 4% oz. 

String beans 9 oz. 

Spinach 7 oz. 

Cabbage 12 oz. 

Purple cabbage 12 oz. 

Cauliflower 12 oz. 

Brussels sprouts 8 oz. 

Carrots 10 oz. 

Turnips 8 oz. 

Oyster plant 6 oz. 

Asparagus 18 oz. 

Tomatoes 18 oz. 

Cucumber 24 oz. 

Radishes 18 oz. 

Ehubarb 18 oz. 

Chestnuts % oz. 

Banana 1 large 

Grapes 4 oz. 

Cherries 6 oz. 

Apple, pear or orange 1 large 

Dried fruit 4 prunes 

Sugar 2 tablespoonf uls 



rote 


id Fat Carbohydr 




Calories 


10 


20 70 


10 


20 70 


15 


20 65 


30 


10 55 


25 


20 55 


25 


— 75 


20 


— 80 


30 


40 30 


10 


55 35 


30 


10 60 


30 


10 60 


35 


10 55 


10 


5 85 


10 


10 80 


5 


5 90 


40 


5 55 


15 


5 80 


30 


10 60 


20 


10 70 


10 


20 70 


10 


10 80 


5 


5 90 


5 


— 95 


10 


— 90 


5 


— 95 


5 


— 95 


— 


— 100 



This table shows how important it is that fruits 
and vegetables make up a large part of the child's 
diet, and that some of these even contain rather 
large amounts of proteids. 

Cooking changes the food considerably ; thus boil- 
ing beef reduces its weight by about one-half, fish 
by one-tenth; roasting meat reduces its weight by 
about one-quarter. 

A sample-diet for a healthy child of eight years 
would be about as follows : 



150 THE CHILD IN HEALTH AND ILLNESS 



Breakfast : 
Cooked fruit 
Cooked cereal 
Bread 

Butter 



one-half cup 

one cup 

two slices 

one-half tablespoonful 



Milk or cocoa one cup 



Dinner : 
Pea soup 
Chop or fish 
Eice or macaroni 
Potato 

Green vegetable 
Bread 
Butter 
Pudding 
Supper : 
Cereal 
Bread 
Butter 
Cooked fruit 
Milk 



one cup 

one chop, fish piece 3"x 2"x 1" 

one cup 

one medium 

one-half cup 

two slices 

one-half tablespoonful 

one cup 

one cup 

three slices 

one-half tablespoonful 

one-half cup 

one cup 



Coffee, tea and alcohol should not be allowed as 
beverages for children ; they are artificial stimulants 
and the healthy child does therefore not require 
these ; in sickness it must be left to the physician to 
prescribe these in carefully regulated doses and for 
a limited time only, whenever he should consider 
their administration demanded by the condition of 
the patient. 



THE FEEDING OF CHILDREN 151 

Spices also have no place in the dietary of the 
child with its active life and its normal appetite; 
they are only liable to injure the tender lining of 
the stomach. 

Candy may be given to the child in small amounts 
as a reward, but only the best quality; much of the 
cheap candy which is sold is made up of substitutes 
for sugar and of artificial flavouring and is actually 
harmful. Good candy is best given to the child 
after meals, if it has emptied its plate ; when given 
between meals it is liable to be eaten in too large 
quantities and then to spoil the appetite and the di- 
gestion as well; frequently children are seen by the 
physician, especially after the holidays and after 
children's parties, suffering from acute symptoms 
of poisoning due to large amounts of sweets; some 
children are very susceptible to sugar. 

The bad habit of covering cereals thickly with 
great quantities of sugar must also be mentioned, 
as one w^hich may cause harm. 

The so-called "strengthening diet" which is still 
so often ordered for pale and weakly children, one 
with plenty of milk at meals and between meals, 
and then some more, and rare roast-beef or steak, 
not to forget eggs in all forms from raw ones up, 
must not be forgotten here. What is the usual re- 
sult of this "strengthening diet"? The child will 
most likely suffer from constipation or diarrhoea 
or both alternately; its complexion will be yellowish, 
it will have a tendency to skin-troubles; its sleep 
will be poor; it will develop nervous symptoms, and 



152 THE CHILD IN HEALTH AND ILLNESS 

if we take its temperature regularly we will find 
that it has slight fever. In short we will find that 
this kind of diet is anything but strengthening and 
all these symptoms will vanish as by a miracle as 
soon as we regulate the child's diet, reduce the ani- 
mal food to a minimum and see to it that the diet 
is composed of the right proportion of all the ele- 
ments of the food. 

Unfortunately we still have to contend with a 
great amount of prejudice and ignorance in the 
feeding of children, and mothers will always find 
that they must strenuously resist the well-meant 
but meddling interference of relatives and friends ; 
they must be firm, realising that it is the welfare of 
their own offspring which is at stake. 

Individual differences and innate or acquired 
physical or psychical aversions must be duly consid- 
ered; any experienced mother or nurse will know 
that certain children can not be made to partake of 
certain foods without being made ill by them, and 
quite frequently we will find the same aversion in 
some other member of this family. Some foods may 
actually have the effect of a poison, such as for in- 
stance strawberries, or the crustaceans or bivalves. 

Geographical as well as racial differences, and lo- 
cal tastes and customs, also demand consideration. 

The social conditions of the parents play an im- 
portant part in the dietary of children, not because 
it is in any way difficult to provide the food for chil- 
dren at a very reasonable outlay of money, but, on 
the contrary, because among the well-to-do things 



THE FEEDING OF CHILDREN 153 

are frequently given because they are expensive and 
bear a high-sounding name and are therefore con- 
sidered to be correspondingly good and nourishing. 
The healthy child does not require anything but 
what can be found in the ordinary store and what 
can be bought by every family ; the sick child would 
very frequently be better off for a simpler and more 
natural diet, instead of all kinds of patented and 
proprietary foods of more or less, usually less, enig- 
matical value. Nor must we forget either that this 
is the age at which all the organs, those of digestion 
included, are developing, and that they can be de- 
veloped only by the exercise of their functions. How 
can we expect that the gastro-intestinal canal will be 
in a fit state later on in life if we keep it weak now 
by feeding predigested foods? 



CHAPTER XII 
THE CLOTHING OF CHILDREN 

THE clothing of the child should always be regu- 
lated according to the surrounding tempera- 
ture, indoors as well as outdoors. It should be such 
as to prevent any sudden chilling of the body, but 
on the other hand it should not be so heavy as to 
interfere with the free movements of the limbs or 
to keep the child bathed in perspiration ; in summer 
it should be especially light and it should be reduced 
to the most necessary articles only. 

It is a very common mistake in this country, where 
the houses are usually overheated in winter, to have 
the child wear heavy clothing indoors as well as for 
playing outdoors. In summer nothing is better for 
young children of both sexes than rompers (see Fig. 
43) made of gingham or some other light material; 
they allow of free motion and offer at the same time 
protection of the body. 

Boys from about the end of the second year are 
put in suits with trousers; girls wear dresses with 
bloomers which they can and will now frequently 
wear until they are grown up (see Fig. 44); for 
romping around and for gymnasium work the skirts 
can be removed. 

i54 








Figure 4 3. rompers 



FTGURE 44. BLOOMER DRESS 





FfGURE 45. SUSPENDER 



FfGURE 46. NIGHT DRAWERS 



THE CLOTHING OF CHILDREN 155 

The principal thing to avoid in the clothing is 
the constriction of the vital organs contained in 
the chest and the abdomen ; all clothing must there- 
fore be hung from the shoulders by means of a 
waist or special suspenders (see Fig. 45) and it must 
not be fastened around the middle of the body with 
constricting bands. Nor should the stockings be held 
by encircling garters, but the garters should run up 
along the thigh and be fastened to the waist. 

For night-wear at first night-drawers with feet 
(see Fig. 46) are the most sensible for young chil- 
dren who kick off their bed-clothing during their 
sleep; for older children pajama suits (see Fig. 47) 
are to be recommended. This will also fully protect 
them when they run around in the morning after 
getting up, which all children love to do before they 
are dressed. 

For outdoor wear in cold weather we should fol- 
low the Chinese plan of wearing several layers of 
light clothing in preference to single and very heavy 
pieces of outer clothing. In cold weather the child 
should be made to wear mittens, knitted jacket or 
sweater and legging drawers, also a cap which pro- 
tects the ears (see Fig. 48). 

High tight collars and fur boas should be shunned ; 
the neck should be exposed to the fresh air and for 
this reason the sailor-suits and middy-blouses are 
the best. 

Head-wear should only be worn for the protec- 
tion against sun-rays, against rain and cold; other- 
wise the head should be bare ; this wdll make the hair 



156 THE CHILD IN HEALTH AND ILLNESS 

glossy and strong and thick and it will undoubtedly 
prevent early baldness in young men. 

The feet should be shod with strong, broad-toed, 
sensible leather shoes which should be laced to pro- 
tect the ankles from strains (see Fig. 49). In sum- 
mer low shoes and sandals may be permitted. The 
legs should be covered with stockings. The foolish 
fashion of sending children out in all kinds of 
weather with bare legs and thin socks can not be con- 
demned too severely; this is the outcome of a mis- 
taken idea of the so-called hardening process which 
only really strong children can stand, but which will 
never make weakly children strong. In summer the 
legs should also be covered to protect the child 
against mosquito bites and against slight injuries 
when playing. If we want to allow our children to 
go with bare legs in very hot weather, then they can 
go barefoot or with sandals. In w r et weather the 
feet should be protected by wearing rubbers or in 
very cold weather and on high snow by arctics over 
the shoes. 

Dame Fashion should have no voice about what 
children should wear ; the clothing should be simple 
and appropriate, and the child should not be taught 
to make of itself the slave of costly clothes which 
interfere with its natural desire for free exercise of 
the body and the training of all the muscles. In 
girls we should take a decided stand against the 
wearing of corsets which will keep the muscles of 
the back from developing properly, by partially, at 
least, supplanting them; a light waist without any 







I -V 






i v. 



1 I 












IGURE 4 7. PAJAMAS 



Ftgure 4R. winter clothtng 






Figure 49. shoes 



Figure 50. waist for young 
girls 



THE CLOTHING OF CHILDREN 157 

stays (see Fig. 50) is the only thing which we should 
allow, and in this manner we will save the future 
woman many a back-ache and many a day of invalid- 
ism. Boys should be given ordinary suspenders as 
late as possible, because they are liable to make 
them stoop-shouldered; tight belts should not be 
allowed. 



CHAPTER XIII 
THE EDUCATION OF THE CHILD 

A BOOK like this can not attempt to cover 
the education of the child in all its complexi- 
ties and perplexities; the mother or nurse who is 
interested in this subject — and who is there who 
loves children and who has to do with their bringing 
up who would not be deeply interested in the most 
wonderful development which goes on in the mind of 
the child? — will find a great many books on educa- 
tion, some of which, as for instance those written bv 
Gr. Stanley Hall of Clark University, can be highly 
recommended. 

Here we can only attempt to give a cursory re- 
view of the main points to be followed in the rear- 
ing of children while we have to leave the details to 
personal study. 

At what age can we begin with the education of 
the child? 

We can begin by educating the infant, and if we 
will only look for them we will be able to find many 
a spoiled child of less than one year old. 

As soon as the child's memory is sufficiently de- 
veloped to retain impressions we can begin with 
education, even if the intelligence is not such as 

158 



THE EDUCATION OF THE CHILD 159 

to grasp the connection between cause and effect. 
Memory however is sufficiently developed at an 
early time. 

The system of nursing or feeding infants, as ad- 
vised in this book, is not only the most health- 
ful, but it is, at the same time, educational, in that 
it trains children from the very first days of life 
to order, regularity and abstemiousness. 

The time to get a young child to keep its clothes, 
its bed and itself clean and to announce in due time 
its desire to fulfil its natural functions of excre- 
tion is the end of the first or the beginning of the 
second year of life. For a time, during the transi- 
tion period, the child will give notice, but only when 
it is too late, and this may be so for a longer or 
shorter time according to the individuality of the 
child and the more or less earnest collaboration on 
the part of the mother or the nurse. Once a child 
has learned this lesson it is not likely to forget it 
when it is well, though it may forget itself occa- 
sionally when deeply interested in its play. Older 
children who wet their bed usually lack in will- 
power or they are sick and the physician should be 
consulted about them. Young children when they 
are taken ill will also frequently forget the lesson 
of neatness they have learned and will have to be 
taught once more. 

When the baby is weaned and the food has to be 
changed we will often have to go quite slowly be- 
cause the child may refuse strenuously this change, 
though we w r ill always succeed by firm perseverance ; 



160 THE CHILD IN HEALTH AND ILLNESS 

naturally we will always find it a much harder tasl 
to make the child eat things it does not like than to] 
keep it from eating things it should not have. Vege- 
tables especially, which, as we have seen, are of such] 
great importance in the feeding of children, are fre- 
quently very difficult to administer to children; 
sometimes even after the child has eaten them nicely 
for some time it may, suddenly and without any ap- 
parent reason, refuse them; but with firmness and 
with the necessary tact we will always succeed, pro- 
vided naturally that the child is not actually ill 
The same may be said about medicines, especially 
our good old standby, castor oil. If the mother ap- 
proaches the child hesitatingly with the medicine- 
spoon in her hand, showing by her very expression 
that she fears and expects that it will refuse to take 
it, then the child will most likely, and quite natu- 
rally, do so ; if on the other hand she is quietly firm 
and persistent the child will soon understand that 
taking the medicine is the easiest way out of an un- 
pleasant situation. The child will give in as soon 
as it realises that the will of the mother or nurse is 
stronger than its own. In very many cases when 
the mother fails to be able to make the child take 
something it does not like, the father, if he will take 
the child by himself alone, will readily succeed. 

From the time the child is eighteen months old it 
should be taught to eat alone and it is then extremely 
important not only that it eats but how it eats. It 
should be taught from the very beginning to carry 
the cup to its mouth with both hands and to drink 



THE EDUCATION OF THE CHILD 161 

without spilling; it should also be taught to eat its 
pap or its vegetables with a spoon and to use a 
pusher to get the food into the spoon (see Fig. 52), 
as this will be done rather slowly at first the food 
should be served on a hot water plate (see Fig. 51). 
This niay take a few months to accomplish, but the 
child must acquire table-manners as early as pos- 
sible, as the lack of these will always be a sign of 
a neglected bringing up. In teaching the child early 
how to eat alone we will also give it self-confidence, 
and a child who has been taught this early will also 
be able to dress itself early, without aid, and it will 
thus acquire to a considerable degree that inde- 
pendence which will be necessary for it in later life. 

Speech is an accomplishment which the child has 
to acquire gradually, though it can produce sounds 
from the very time of its birth ; these sounds are the 
expression of bodily sensations to indicate that it 
is hungry or thirsty, or that it has pains or is un- 
comfortable. Soon the child will learn to use its 
crying as a call for aid when it has one of these un- 
comfortable feelings and it will also produce sounds 
as an indication of its well-being and its pleasure 
and no less its displeasure. 

Real speech, which is a combination of the faculty 
of taking up words through the ear and the repro- 
duction of these with the vocal apparatus by im- 
itation, begins at the end of the first year of life, 
when the child will be able to repeat a few simple 
words such as mamma and papa, which are really 
only reduplications of the words ma and pa ; we will 



1 62 THE CHILD IN HEALTH AND ILLNESS 

notice that the child will at first usually duplicate 
the words or syllables of words which it learns to 
utter. This will soon be followed by the formation 
of simple short sentences, and later it will learn the 
use of the important little noun "I" which will in- 1 
dicate the clear understanding of its own person- 
ality. 

Some young mothers delight to such an extent in 
the first "baby-talk" of the child that they encour- 
age its continuance by answering it in the same man- 
ner; this is a mistake, as it will lengthen consider- 
ably the time before the child will know how to talk 
rightly, and occasionally we will hear children of 
from four to six years who still use this mode of 
expression. 

Defects of speech, such as halting, stuttering, 
stammering and the faulty pronunciation of such 
letters as "s" or "r," should be early attended to, 
before the faulty habit has become fixed; in older 
children it will require a great deal of patience and 
endeavour on the part of specially trained phy- 
sicians to eradicate such defects which are liable to 
cause the child a considerable amount of unpleasant- 
ness, to say the least. 

It is very necessary to teach the child to talk 
rightly from the very first. 

In educating children we must always remember 
the one principal fact that children are imitative 
creatures, both in their speech and in their actions, 
and parents or nurses will often be unpleasantly 
surprised to hear or see their mannerisms repeated 



THE EDUCATION OF THE CHILD 163 

in an unmeaning but correct way. We must there- 
fore be extremely careful in our own speech and 
in our behaviour, and if the children are to be left 
to attendants we must be perfectly sure of the pur- 
ity of their talk and their morals to save ourselves 
from such surprises for which we are liable to blame 
or even punish the child rather than the person 
really responsible for this. 

Egotism is innate in the child and is the outcome 
of the natural tendency for self-preservation; the 
child does not bring into the world any knowledge 
of the difference between mine and thine ; it has to 
be taught this. The thoughtlessness towards ani- 
mals is also inherited from our ancestors and it 
must be combated from the very first. Truthful- 
ness is also acquired only by education and experi- 
ence. 

The child is born without fear of anything and it 
is only through faulty bringing up and through the 
telling of ghost-stories and such that they are made 
to fear the dark or that they are afraid of the harm- 
less animals. 

The best way to cure a child from self-will, ego- 
tism, thoughtlessness and fear is by the good ex- 
ample set them by the adults in their surrounding 
and even more so by their close contact in play with 
children of their own age, where the child will learn 
to subject its own personality to that of others and 
to regulate thus unwittingly its relations to the 
outer world. 

As the child gets older we so influence its play at 



1 4 THE CHILD IN HEALTH AND ILLNESS 

home, when it is alone, as to lead it slowly towards 
useful occupations and to the use of its hands and 
the employment of tools. Modern technique has 
made this quite easy by furnishing all kinds of 
toys, both for boys and girls, with this idea in view, 
and we can thus stimulate at a comparatively early 
age the constructive and inventive faculties of the 
mind. 

One thing we must never forget, in this education 
of the hands of the child, namely, to preserve its 
natural ambidexterity; nor should we insist on the 
use of the right hand in children who are naturally 
left-handed. 

The child has to learn everything through its own 
experience and the old saying that "the burned child 
fears the fire" is true only when the child really has 
been burned and therefore knows why to fear the 
fire. The young child will quite naturally find it 
extremely difficult to profit by the experience of its 
parents or attendants ; it is of an investigating state 
of mind and very receptive to external impressions. 
It is therefore necessary to let the child gain this 
experience for itself, without, however, exposing it 
to any actual danger. Some overcareful parents 
try to save their offspring from passing through this 
school of experience and they go to extremes in 
guarding them against all, even imaginary, dangers, 
with the final result that the child has to learn most 
of these things for itself later in life and that it will 
thereby be under a serious handicap. 

The fear of bacteria assumes at the present time 



THE EDUCATION OF THE CHILD 165 

some ludicrous aspects; we need only refer to the 
children who are allowed to play exclusively in steri- 
lised sand, who are not permitted to bite into an 
apple or to pot an animal, and so on. These are the 
people who will later in life be consumed with an ab- 
normal dread of contamination ; they may then suf- 
fer from the so-called "phobias" or abnormal fears, 
which may assume all kinds of forms, such as the 
constant washing of hands after touching some ar- 
ticle, or the fear of travelling in a railroad-train, or 
eating in a restaurant and many others, which will 
be very difficult to eradicate and which will cause 
the individual considerable inconvenience, to say the 
least. 

One word about the playthings given to the young 
child. These should be of the very simplest and as 
few r as possible. The child itself will regulate this 
to a large extent. How often can we see at Christ- 
mas time its table covered with the most wonderful 
toys of all kinds and the little one will after a 
cursory glance at all this splendour return to its 
old, worn-out, headless doll. The children who have 
the most toys are the ones who are usually the least 
satisfied and who will cry for the moon because 
they expect their fond parents to indulge them in 
every wish. 

The actual teaching of children should be deferred 
as long as feasible. For the first six or seven years 
the child's brain will be so much employed in the 
storing up of the useful knowledge gained by ex- 
perience that any other teaching would be liable to 



1 66 THE CHILD IN HEALTH AND ILLNESS 

overburden this delicate organ. Some parents pride 
themselves on teaching their little ones to read and 
write at a very early age ; they teach them all kinds 
of little pieces of poetry and they delight in boasting 
about the advanced state of the knowledge of their 
children, but they do not realise that they are really 
shortening the happiest time of life, that of care- 
free, early childhood, and that their so-called clever 
children are on the same mental plane with the 
trained animals in the circus. 

Schooling may begin at seven years of age or bet- 
ter later and the child will then be able to make up in 
a very few weeks what it has taken its less fortunate 
mates months to accomplish. 

Kindergartens are not good for children; true, 
they are a great convenience for mothers with large 
families who have to attend to their own households, 
but they are also the means of spreading catching 
diseases, and the time spent in the close schoolroom 
would be spent to much greater advantage for the 
child in untrammelled outdoor play. 

Ambitious parents should never attempt to drive 
the child in school nor should they attempt to have 
it pass through school in the shortest possible time ; 
the healthy child will regulate this itself. Naturally 
in some children, especially in boys, we must fre- 
quently use all our efforts in overcoming their nat- 
ural aversion to the restraint of the school and to 
subdue, to some extent at least, their healthy animal 
spirits. 

Some children are very difficult when it comes to 



THE EDUCATION OF THE CHILD 167 

getting them accustomed to school and they do not 
do as well as their natural abilities would lead us 
to expect; still these same children may do very 
well under another teacher who succeeds in getting 
them interested in their work, and that a child has 
been a poor scholar does not mean at all that it will 
also not do well later in life in its chosen profession. 

Other children are backward in school because 
they are handicapped by some unrecognised physical 
defect. Since the examination of pupils in the 
schools has been carried out by school-physicians at 
regular intervals a considerable amount of good has 
already been accomplished. 

How many times do we observe a child who is 
backward in school because it is deaf in one ear, 
unbeknown to itself, its parents or its teacher, and 
who is sitting at one end of the class with its deaf 
ear toward the schoolroom, and how this same child 
succeeds in getting to the head of its class as soon 
as its place in the room is changed to the other 
side, so that it can now hear everything. 

Or the child whose eyes are defective and who 
does its work well after it is given glasses to cor- 
rect its vision, doing away at the same time with 
the headaches from which it had been suffering so 
often. 

Or the child with adenoids and enlarged tonsils 
which is kept back by these abnormalities, but whose 
standing in school improves at once after a slight 
operation which insures free access of air to its 



168 THE CHILD IN HEALTH AND ILLNESS 

lungs through the natural channels ; which improves 
its hearing at the same time. 

Only one point more about schooling. A word 
about the frequent examinations now required and 
especially the so-called "regents' examinations " in 
vogue in the State of New York and perhaps under 
other names in other states. 

The idea of having to pass an examination is fre- 
quently sufficient to disturb the minds of otherwise 
healthy but high-strung children, and they are bound 
to increase this nervousness to a high degree. An 
intelligent teacher should be able to judge the stand- 
ing of a child by its daily work, without resorting 
to any special tests of knowledge crammed into the 
child's brain a few days before an examination, 
which will quite naturally be forgotten again just 
as quickly. 

But why we should have our children subjected, 
at frequent intervals, to examinations prescribed 
by a special board which is not in touch with the 
work done in that particular school, and worked out 
by political appointees who are not in touch with 
that particular teacher, is beyond the waiter's under- 
standing. Children should be taught for life, not for 
examinations. 

Furthermore, we must not forget that these ex- 
aminations come at a time in life when the body is 
in the stage of transition, at the time of puberty 
when the system, especially in girls, is rearranging 
itself to entirely new conditions, when the organs for 
the reproduction of the race are developing their 



THE EDUCATION OF THE CHILD 169 

function, and when the upheaval in the organism is 
liable to cause more or less of nervous symptoms. 
Why should we permit our children at this critical 
time to undergo the further strain of senseless ex- 
aminations ! 

Finally, a few words about music-lessons given at 
the home and the daily practicing they require. 
Many children are forced to learn some instrument 
because it is fashionable, though they do not possess 
any ear for music nor care for it at that time ; these 
children would much better spend the time wasted 
at the piano or some other instrument outdoors in 
healthful play. The child who has a natural gift 
for music will show this early enough, and these 
are the ones w T ho should be encouraged and aided. 

Dancing lessons are good for children, provided 
they are given in daytime and not, as is too fre- 
quently the case now, at night. They develop the 
graceful movements of the body and are of great 
educational value in teaching the little men and 
women manners and courtesy toward each other. 

Evening parties for children of school-age are 
one of the worst features of life at the present time. 
Children do need a great deal of sleep and until 
after puberty is completed they should be in bed at 
eight o'clock at the latest, at least in winter; in hot 
summer weather and especially during vacation time 
when they can sleep longer in the morning they may 
stay up a little later; the trouble is however that 
most children wake up early in the morning and 
they should therefore get a good part of their rest 



170 THE CHILD IN HEALTH AND ILLNESS 

in the forepart of the night. Visiting theatres at 
night and especially the moving picture shows is 
also a bad thing for growing children. Nor must 
we forget that it is equally bad to burden a child 
with lessons from school to be done at home, which 
will either rob them of the time for outdoor recrea- 
tion or will keep them up until late into the evening. 



CHAPTER XIV 

THE INFECTIOUS AND CONTAGIOUS DIS- 
EASES OF CHILDHOOD 

THEIR PREVENTION 

MINUTE plants or animals, — the former the so- 
called germs or bacteria, the latter the so- 
called protozoa, — may enter the body of the child, 
here to cause diseases either through their growth 
or through the poisonous substances they produce. 
These diseases may be transmitted by means of 
articles of clothing or of food, such as water, milk, 
raw vegetables and fruits, when we call them in- 
fectious diseases, or they may be transmitted from 
one person who is carrying the disease to another 
individual who is not immune against this disease 
and is therefore susceptible, in which case we speak 
of a contagious disease ; it is however important to 
know that in this latter case the person transmitting 
the disease must not necessarily be sick himself, but 
that he may simply harbour these germs in his sys- 
tem, in which case we call him a disease-carrier. 

A certain amount of immunity, that is resistance 
against infection, is brought into the world by the 
child owing to the fact that its mother has had some 

171 



172 THE CHILD IN HEALTH AND ILLNESS 

of these diseases at some time or other before its 
birth and that she thus still carries in her blood cer- 
tain substances, the so-called antibodies, which make 
her system an unfavourable soil for those particular 
germs, of which immunity she imparts a small 
amount to the unborn child. More of these anti- 
bodies are transmitted to the baby after its birth 
through the milk of its mother, and this explains the 
fact that infants, especially those at the breast, are 
very rarely attacked by some of these diseases. 

Overcoming an attack of one of these diseases, 
even a light one, will also confer a certain amount 
of immunity to the patient, and this explains why 
most persons suffer from so many of these diseases 
only once during their lives. 

Recently we have also learned that by introducing 
into the system of a person a small amount of the 
dead germs causing a particular disease we can 
stimulate the body to produce some of the antibodies 
against it and that we can thus confer at least 
temporary immunity against this disease; this is of 
great importance at the time of epidemics and when 
a person expects to be specially exposed to a certain 
disease. 

The most important point in the prevention, or, as 
it is also called, the prophylaxis of the contagious 
and infectious diseases is cleanliness, of the child 
itself as well as of its whole surroundings, and to 
avoid everything that might be contaminated. Nat- 
urally this must not degenerate into a morbid fear 
of all bacteria, but it is just as well to realise that 



CONTAGIOUS DISEASES OF CHILDHOOD 173 

we can succeed to a very large extent in preventing 

these diseases by cleanliness, and we must under- 
stand of what this cleanliness consists. 

Everything in the child's immediate surrounding 
must be kept scrupulously clean, and it should there- 
fore be of such a colour as to show even the least 
vestige of dirt. Carpets, matting and upholstered 
furniture should be banned from the nursery as 
dust collectors; the floors may be of hardwood or 
covered with linoleum, the furniture covered with 
oilcloth of some light colour or with chintz. 

As children, especially the younger ones, spend a 
large part of their time on the floor, they must be 
taught as early as possible not to pick up things 
from the floor to put them into their mouths, nor to 
eat any food after it has dropped on the floor. 

While it is by no means necessary to be after 
children all the time to make them keep their clothes 
and hands clean, we should teach them early that 
the hands should be washed frequently, especially 
every time before touching food. 

Travelling in railroads, streetcars, visits to the 
stores and public gatherings of all kinds, also the 
public play-grounds, frequently expose children to 
infection and should therefore be avoided as much 
as possible, nor should we allow strangers to touch 
the children nor to shake their hands, and the child 
should know this itself. 

This cleanliness also includes the child's mouth; it 
should be taught to keep its teeth clean and to brush 
them daily, not only on arising and before retiring, 



174 THE CHILD IN HEALTH AND ILLNESS 

but also after every meal, to remove the little par- 
ticles of food which might remain. It should also 
be taken to the dentist, at least once every three 
months, to have its teeth examined and small cavi- 
ties filled which could harbour germs. 

( hildren should learn as early as possible to gar- 
gle, not only to keep their throats clean but so that 
they will know how to do this when they have an 
illness; for the same reason they should also be 
accustomed to have their tonsils inspected at fre- 
quent intervals, at least every time the child is not 
feeling well, then the physician will not have to fight 
his little patient when it is urgent that he should 
examine the tonsils. Systematic washing out of the 
nose with a mild antiseptic solution should be made 
a routine measure every morning and evening; we 
know that the nose is the filter for the inspired air 
and the germs will therefore lodge here, and they 
must be removed before they can do any harm; 
otherwise they will find a convenient place back of 
the nose between this and the throat, in the so-called 
third tonsil; this will enlarge from inflammation 
and then form the so-called adenoids. Since the 
writer has advised this systematical washing out of 
the nose he has seen a great many less cases of ade- 
noids than he did before. 

An important point in the prophylaxis of infec- 
tious diseases is the hardening of the children so 
that they are not so easily affected by chilling of 
the body. This hardening process is in reality a 
form of gymnastics for the blood-vessels of the skin, 




Figure 51. hot water plate 
for young child 




*s 



Figure 52. eating utensils for children 




FIGURE 14. CLOTHES-BASKET AS BED 




FIGURE 15. IRON BED 



CONTAGIOUS DISEASES OF CHILDHOOD 175 

so that these contract and dilate at the proper time 
in order to protect the body. In this we can succeed 
in two ways, either with air by letting the babies lie 
naked on a hard mattress and allowing them to kick 
to their hearts' content and permitting older chil- 
dren to run around in the room in their nighties ; or 
we can do this with cool water, after the warm bath 
in younger children and by cold sponges every morn- 
ing in older ones. School-children will not dread 
the brisk cold winter-weather if they are accustomed 
to taking a plunge in the bath-tub every morning, 
the tub having been filled with cold water the night 
before. Naturally it is not every child which will 
stand this hardening process equally well; the prin- 
cipal point is that they have a good reaction after 
it and this can be observed by the healthy glow of 
the skin when they come out of the plunge ; should 
their skin remain cold and clammy and should they 
be shivering then we should desist and try other 
measures first until the blood-vessels in the skin have 
been properly exercised. 

Should one of the children in a family or a house 
suffer from an infectious or contagious disease, then 
the other children should be kept away from the 
patient who must be isolated. It is not permissible 
to deliberately expose a child to any one of these 
diseases, and we must remember that the disease 
may be very severe in the child so exposed even if 
it should have been very mild in the first case. 

In times of epidemics all gatherings, such as 
churches, play-grounds and children's parties, should 



176 THE CHILD IN HEALTH AND ILLNESS 

be shunned ; the parents have not only the right but 
it is their duty to keep the children out of school 
until all danger of infection is past. 

The health-laws existing in the different states 
and communities are very definite and more or less 
strict; if they are always conscientiously obeyed a 
great deal of illness, especially in children, can be 
avoided. Unfortunately many, even among the in- 
telligent people, are still inclined to regard these 
laws as an infringement of their personal liberty, 
and they do not seem to realise that these measures 
are passed for their own protection and benefit. The 
sooner the people at large understand this, and the 
sooner they learn to obey these laws implicitly, in- 
stead of selfishly expecting obedience in others only, 
waiving it in their own cases, just so soon shall we 
see a lessened incidence of these diseases, thus sav- 
ing ourselves and our children from a great deal 
of suffering and perhaps permanent invalidism, if 
not untimely death. 

We should regard the placarding of houses and 
the strict quarantine in certain of these diseases 
which we know to be highly contagious, a temporary 
hardship though this may be, as one of the neces- 
sary measures to protect the public health, and as 
one which confers the greatest good to the largest 
number of people, and which is, therefore, accord- 
ing to the constitution of our country, not only per- 
missible but desirable, and for the best of humanity. 
Though medical science and hygiene have made 
tremendous strides in the prevention of preventable 



CONTAGIOUS DISEASES OF CHILDHOOD 177 

diseases, of what will all this avail us if we do not 

learn at the same time to benefit from these ad- 
vances f 

It is a very necessary preventative measure, too, 
to call in the physician at once in every feverish 
illness, as he alone is qualified to make a correct 
diagnosis, though at times it may be quite difficult 
or perhaps impossible even for him to do so at his 
first visit. 

After a child has recovered from an infectious 
disease disinfection of the premises, the bed, the 
clothing, utensils and furniture is generally consid- 
ered necessary to prevent any further infection in 
others. 

The best preventative would be to make it compul- 
sory to send every case of an infectious and still 
more of a contagious disease to a properly equipped 
hospital, as is done in England, for instance, where 
they have a sufficient number of so-called "fever- 
hospitals," and to place the rest of the family under 
strict quarantine at their home until we can be cer- 
tain that no new cases will develop. In many of 
our larger cities with their truly admirable munici- 
pal and other hospitals this should easily be done, 
and can be done if the people will only realise how 
much better it would be to have these patients taken 
care of in an institution which is built and prepared 
for the reception of these cases, and where every- 
thing which might be needed in an emergency will 
be at hand, and where specially trained physicians 
and nurses are in constant attendance. In many 



178 THE CHILD IN HEALTH AND ILLNESS 

cities however and especially in the smaller com- 
munities the so-called quarantine hospitals, or, as 
they are still called sometimes, "pest-houses," are 
not such as to make it even advisable to send our 
children to them in case of illness ; and this explains, 
to a large extent, the aversion many people still have 
against all such institutions. 



SPECIAL PROTECTION AGAINST INFECTIOUS DISEASES 

Vaccination 

We know that many of the infectious and con- 
tagious diseases attack men or susceptible animals 
only once in a lifetime, and that passing through 
the disease, no matter how lightly, will confer pro- 
tection against reinfection with this particular germ. 
By experimentation it has been found that we can 
protect animals against certain bacterial poisons by 
carefully injecting into them these poisons in small 
doses, only sufficient to make the animal slightly 
sick, then slowly increasing the dose until finally 
the animal is able to withstand many times the dose 
of the poison w T hich would be absolutely fatal to an 
animal not so treated. 

In olden times it had been observed that the ac- 
cidental infection of small wounds in the skin with 
the contents of smallpox pustules would cause a 
local eruption, and following this an attack of small- 
pox, which, however, was usually very light; this 
method was therefore employed to a large extent 



CONTAGIOUS DISEASES OF CHILDHOOD 179 

up to the beginning of the last century to protect 
people against the ravages of smallpox. It was 
found, however, that in about two out of every one 
hundred children thus inoculated the disease was 
not of the expected light form, but ended fatally. 
Furthermore, these inoculated people were suffer- 
ing from real smallpox and thus formed a means for 
the spread of the disease, which in turn was not 
necessarily light. 

In the year 1798 appeared a paper by the English 
physician Edward Jenner which attracted wide- 
spread attention. In this he proved that the pustules 
found occasionally on the udders of cows were 
closely related to human smallpox, and that persons 
who contracted this cowpox while milking affected 
cows were immune against smallpox. 

This artificial inoculation with cowpox has been 
of inestimable benefit to humanity. Before the ad- 
vent of vaccination smallpox was universal and was 
considered a disease of children because hardly any- 
body escaped it during childhood, so that it was re- 
garded to be a special mark of beauty for anybody 
not to be covered with the pitted scars of the dis- 
ease. Smallpox never was, nor is it now, a disease 
of the poor and of those who live in unsanitary sur- 
roundings ; the wealthy and even the highest in the 
land suffered and died from it. It is known that 
during the last years of the eighteenth century 
400,000 people died annually from smallpox in 
Europe alone. During the Franco-Prussian war in 
1870 to 1871 the Germans, who were mostly pro- 



i8o THE CHILD IN HEALTH AND ILLNESS 

tected by vaccination, had only 5,000 soldiers sickl 
from smallpox, and these mostly Bavarians amongl 
whom vaccination had not been carried out carefully, 
while of the unvaccinated French soldiers 23,000 
died from smallpox; this is the more remarkable 
when we stop to consider that the wounded of both 
armies were taken care of side by side in the hos- 
pitals. Since the year 1874, in which vaccination 
was strictly enforced by law, not a single epidemic 
of smallpox has occurred in Germany, nor has the 
mortality from this disease exceeded one in each 
million of inhabitants, and this though in the adjoin- 
ing countries, such as Russia and France, small- 
pox has demanded many victims during the same 
time. In the Dual-Monarchy Austria still has many 
cases each year, while in Hungary with its strict 
laws enforcing universal vaccination smallpox is 
practically unknown. 

The only drawback to vaccination is this, that its 
effect is not lasting, and that it confers protection 
for not more than seven years, and that it must, 
therefore, be repeated before the end of this period. 

From its very beginning this remarkable dis- 
covery of Jenner has had to encounter the abuse of 
the ignorant and the fanatics, and this is still so at 
the present day. The antivaccinationists, bereft of 
judgment and truthfulness, in their fanaticism, know 
how to catch the masses by prating about the smear- 
ing in of putrid pus, by referring every disease, no 
matter how remote, to vaccination and by warping 
trustworthy statistics to suit their own peculiar 



CONTAGIOUS DISEASES OF CHILDHOOD 181 

theories. They prate about the transmission of dis- 
eases through vaccination; of tuberculosis for which 
they can not bring* a single incontrovertible positive 
case; of syphilis, which may have happened when 
vaccination was carried on from one person to the 
other, but which is impossible now when we use 
animal lymph; of tetanus or lock-jaw, which is im- 
possible when we realise that these germs can not 
thrive when they are exposed to the air; of septic 
infections and erysipelas, which may arise when 
vaccination is done carelessly and without the neces- 
sary surgical cleanliness or if the pustule should be 
scratched with the dirty finger nail or nibbed by 
the dirty clothes ; the vaccine itself does not contain 
any disease-producing germs and with a little care 
we can easily avoid accidental infection. 

Course of Vaccination 

Vaccination is done by making from three to 
five distinct scratches into the skin which are sep- 
arated by at least one-half inch and which are one- 
half inch long (see Fig. 53) ; they are made on the 
upper arm over the outside of the fleshy part, but in 
girls they may be made on the outside of the leg just 
above the knee ; these scratches must be deep enough 
to go through the outermost layer of the skin, but 
just short of drawing blood. Into these we rub the 
glycerinated vaccine prepared from the inoculation 
of healthy animals, usually calves. 

About twenty-four to thirty-six hours later the 



1 82 THE CHILD IN HEALTH AND ILLNESS 

sites of the vaccination begin to redden and from 
now on they show a swelling, which increases up to 
the fifth day, when the pustules begin to develop; 
these are completed by the seventh or eighth day 
(see Fig. 54) ; the surrounding skin is now red, 
swollen, itchy and slightly painful. On the eleventh 
day the pustules begin to dry up (see Fig. 55) ; scabs 
will form, which come off at the end of the third 
week, leaving the characteristic depressed scars (see 
Fig. 56). 

At the height of the process, about the fifth or 
sixth day, we may observe a slight fever, some loss 
of both sleep and appetite, and the child may feel 
somewhat ill. 

Complications of Vaccination 

Erysipelas and the septic infections are due to the 
carelessness either of the physician, who did not use 
the necessary precautions, and who wrongly consid- 
ered it to consist only in a few slight scratches not 
deserving of the surgical preparation which he 
would not dare to omit in an operation; or of the 
attendant or mother who does not provide the child 
with irreproachable clothing, nor keep its body 
clean, and who does not prevent its scratching itself. 

Infants suffering from eczema who are usually 
scratching themselves continually should not be vac- 
cinated until the eczema is entirely healed, because 
through the scratching the vaccine virus may be 
spread over the eczematous spots and it may here 





* 







PTGURE 53. VACCINATION, FIRST DAY FIGURE 56. VACCINATION SCAF 





Figure 54. vaccination, eighth day Figure 55. vaccination, eleventh day 



CONTAGIOUS DISEASES OF CHILDHOOD 183 

cause a secondary generalised vaccination which 
may look serious for a few days, though under the 
proper treatment the outlook of it is usually good. 

Treatment of Vaccination 

The treatment of a normal vaccination consists in 
the most scrupulous cleanliness and in the preven- 
tion of secondary infections. When the inflamma- 
tion is very pronounced we apply cooling lotions or 
a mild salve, or an indifferent powder, such as sculp- 
ter's clay. 

V 

Protective dressings, and especially the so-called 
vaccination shields, should not be used; they delay 
the drying up of the pustules considerably, and we 
find frequently a bad odour on removing these. 
When these protective dressings are used, we fre- 
quently find the glands in the armpit and at the 
elbow r swollen, and this shows that these so-called 
protective measures not only do not prevent infec- 
tion but on the contrary rather favour it. The 
sooner we allow the pustules to dry up the better. 

From the fifth day when the pustules appear until 
the scabs have fallen off we forego the regular tub- 
bath and allow only sponging in its stead. 

It is the writer's firm conviction, which is based 
upon a careful study of the subject of vaccination 
and upon the perusal of carefully compiled statistics, 
the truthfulness of which is beyond question, that if 
vaccination w r ould be carried out regularly and 
universally in this country, we would not have a 



1 84 THE CHILD IN HEALTH AND ILLNESS 

chance to observe a single case of smallpox, except 
perhaps where it had been imported from some other 
country. This would surely be better than having 
frequent epidemics of this disease and would save 
everybody a great amount of anxiety as well as a 
large expenditure of private as well as of public 
funds. 

It is only by the spreading of the gospel of vac- 
cination and by the controversion of the lying prop- 
aganda of the antivaccinationists that we can finally 
eradicate the scourge of smallpox which is a re- 
proach to the name of any civilised country. 

Inoculation Against Other Diseases 

Tetanus. Lacerated and punctured wounds, es- 
pecially those on the feet which are exposed to dirt 
and to the dejecta of animals, but foremost of all 
those wounds which are caused by the explosion of 
fireworks and by toy-pistois with which we still allow 
our children to celebrate the birthday of our nation, 
form a favourable soil for the germ of lockjaw. 
Once the disease has put in appearance the use of 
the antitoxin will no longer do any good; but as a 
preventative measure it must be administered at 
once in order to prevent this dreadful and almost 
always fatal disease, and a physician must there- 
fore be called at once to inspect any one of these 
wounds. 

Hydrophobia. A mistaken sense of kindness still 
allows of many unmuzzled stray dogs being allowed 



CONTAGIOUS DISEASES OF CHILDHOOD 185 

to run around on our streets ; at any time, especially 
in summer, one of these animals may develop hydro- 
phobia or rabies, and in its blind rage bite other 
animals and human beings, to whom the disease is 
thus transmitted. 

The French scientist Pasteur found that it was 
possible to prevent the outbreak of this dreadful 
disease in those who had been bitten by injecting 
an antidote prepared from the brain of animals 
who had the disease, and that this was possible be- 
cause about six weeks or even more will elapse be- 
tween the time a person is bitten and before the 
symptoms of the disease will develop. 

In order to determine if an animal which has bit- 
ten a person was suffering from rabies it is neces- 
sary to keep the suspected animal under observa- 
tion to see if it will develop the disease, or where 
it had to be killed to send the head of the animal to 
an institution for examination ; this will prevent the 
treatment being given unnecessarily and will save 
the patient and his family considerable anxiety. 

Typhoid Fever. As long as we permit our water- 
supply to be polluted by sewerage and not have it 
everywhere above suspicion and reproach, especially 
in summer-resorts and in rural communities, so long 
will the children be exposed to this unnecessary dis- 
ease; the more so, as typhoid fever is primarily a 
disease of young people. Of late years a great deal 
of work has been done, especially by the members 
of the U. S. Army Medical Corps and the U. S. 
Marine Hospital Service, along the lines of inocu- 



186 THE CHILD IN HEALTH AND ILLNESS 

lation against typhoid fever with splendid results. 

The immunity thus conferred is supposed to last, 
at least at present, for not less than three years. 
In times of epidemics and before children are al- 
lowed to leave home for a visit or a sojourn it is 
therefore advisable to have them immunized against 
this disease. The immunization consists in three 
injections of vaccine at intervals of from eight to 
ten days ; only about two out of every one hundred 
cases so injected show any symptoms in a temporary 
rise of the temperature. 

It now seems as if the best method to protect a 
person against typhoid fever was to inject the anti- 
typhoid vaccine, once in infancy, once in childhood, 
once in youth and once in adult life, though the time 
which has elapsed since the introduction of this pre- 
ventive treatment is still too short to form any 
clear judgment about the exact intervals in which 
it should be administered. 

Diphtheria. Whenever a child in a family is 
taken ill with diphtheria all the other children in 
this family, as well as all those other children who 
had been exposed to the disease, should at once 
be given small, so-called immunizing, doses of anti- 
toxin. These will confer at least a certain amount 
of immunity for the term of three or four weeks. 
"We have also of late learned a method of determin- 
ing which children are in need of artificial immuniza- 
tion and which possess sufficient natural resistance 
against the disease. 

Whooping Cough. Of late a vaccine has been 



CONTAGIOUS DISEASES OF CHILDHOOD 187 

recommended for the prevention of whooping cough ; 
though this has as yet not been proven conclusively 
to be able to prevent an attack of this disease in all 
cases, it should be administered at least in delicate 
children who have been exposed, the more so as it 
has been shown to be entirely harmless. 



THEIK PRECOGNITION 

Scarlet Fever 

Scarlatina is one of the exanthematous infectious 
diseases ; that means an exanthema, a rash, is part 
of its symptoms. Its cause, which is undoubtedly 
bacterial in nature, is not yet known. It is a con- 
tagious disease and as such it follows the roads of 
human intercommunication. The yet unknown para- 
site may live outside the human body, at least for a 
little while, and thus the disease may be transmitted 
through articles which have been used by a patient 
or by healthy people who have been around patients ; 
some cases of the disease may be so light, perhaps 
nothing more than a slight sore-throat, as never to 
be recognised as scarlet fever, and these cases are 
apt to lead, to a large number of infections. Milk 
may also, under certain conditions, and when it is 
not boiled before consumption, transmit the infec- 
tion, and a considerable number of epidemics has 
been traced to this important article of diet. 

Transmission from one child to another is the rule, 
especially because a patient immediately before the 



188 THE CHILD IN HEALTH AND ILLNESS 

stage of the eruption of the rash is extremely inJ 
fectious. 

The stage of incubation, that is from the time tin 
germ is taken into the system until the first symp- 
toms of the disease appear, can be anywhere from 
twenty-four hours to seven days. 

Prodromata, that is preliminary symptoms, are 
rarely observed. Usually the child will go to school 
in its usual good health, at least to all appearances, 
and it will be sent home from there on account of 
vomiting and general malaise; when the physician 
is called he can often make a diagnosis of scarlatina 
at his first visit. 

Nausea, headache, profound exhaustion and high 
fever, around 104 degrees Fahrenheit, are also 
among the first symptoms; in older children these 
are as a rule accompanied by chills; younger chil- 
dren may have convulsions. 

From twelve to twenty-four hours after these ini- 
tial symptoms sore throat will set in, and inspection 
at this time will reveal a deep redness of the soft 
palate, which is usually sharply circumscribed to- 
wards the hard palate ; the tonsils are red and swol- 
len ; often they are already covered with a yellowish 
eoat. The tongue is heavily coated and white on 
its edges ; only later wall it look like a strawberry. 
At this first stage the danger of regarding the case 
as one of sore throat or tonsillitis is very great, and 
as the patient may transmit the disease most readily 
at this time other children in the family may be 
infected if the physician is not called in at once to 



CONTAGIOUS DISEASES OF CHILDHOOD 189 

make the correct diagnosis. Every case of sore 
throat with severe general symptoms, setting in sud- 
denly, should be regarded as suspicious of being 
scarlet fever. 

The typical scarlet rash appears usually at the 
end of the first or the beginning of the second day 
of tbe sore throat. It consists of minute red specks 
in large numbers which are separated at first by 
normal skin, then their number and the intensity of 
their colour may increase to such an extent that 
finally the skin appears from a distance to be painted 
a scarlet red ; on closer inspection we will perceive 
that the spots are all separated and do not run to- 
gether. 

The rash usually shows up first on the trunk, — 
on the chest, the back and the neck, — at times first 
on parts subjected to pressure, as on the buttocks 
and the shoulders, or where skin touches skin, as on 
the inside of the upper arms or thighs. The face 
remains relatively free, and the pallor of the region 
around the mouth, which forms a sharp contrast to 
the feverish redness of the cheeks and lips, is very 
characteristic. The cheeks, the ridge of the nose 
and the temples may show a little of the rash. 

The eruption will have reached its highest inten- 
sity between the third and the fifth day; it will re- 
main at its height for about one day and will then 
begin to fade. By the end of the first or the begin- 
ning of the second week of the illness the rash will 
have disappeared and the skin will sooner or later 



190 THE CHILD IN HEALTH AND ILLNESS 

begin to peel off in large pieces, especially on the 
hands and feet. 

Under the name scarlatina we comprise the light 
cases of true scarlet fever; it is not a disease by 
itself, as is the popular belief, and we must always 
remember that from these cases the most severe 
cases of scarlatina may arise. 

Measles 

Measles is another one of the infectious exanthe- 
mata, the cause of which we do not yet know. It is 
infectious for every age and it is a disease of child- 
hood only because almost everybody contracts the 
disease early in life and thus acquires a lasting im- 
munity, although some individuals may have the dis- 
ease more than once; infants are rarely infected 
before the second half-year of life, especially when 
at the breast. 

The disease is transmitted by contagion and also 
through healthy persons and articles, such as cloth- 
ing, bedclothing, etc.; the poison does not however 
live long on such articles and the usual form of 
transmission is through the congregation of suscep- 
tible individuals in schools, kindergartens and 
asylums. 

The stage of incubation is about eleven days and 
passes usually without symptoms, though in a few 
rare cases the child may appear tired, less inclined 
to play, have light catarrhal symptoms and a slight 
rise of temperature in the evening, which will at 



CONTAGIOUS DISEASES OF CHILDHOOD igi 

once attract the attention of the careful mother. 

The first stage of the disease, the so-called prod- 
romal or catarrhal stage, sets in with a running 
nose, inflamed eyelids and a harsh cough. Nose- 
bleed is frequent, especially in smaller children ; the 
children fear the light and the cough is of a peculiar, 
rough, metallic quality, of a troublesome nature, with 
more or less hoarseness, nor does it show any incli- 
nation to get loose. The child now feels really sick, it 
cries easily, is cross, languid, has no appetite, and 
the fever is up to 102 or more degrees Fahrenheit in 
the evening. About twenty-four hours before the 
rash appears the physician is able to find, in most 
cases, peculiar white spots in the mouth of the pa- 
tient which are quite characteristic. The catarrhal 
stage lasts altogether about three days. 

The rash begins usually on the face, around the 
eyes and mouth, whence it spreads to the trunk and 
lastly to the extremities. At first it is composed of 
minute light-red specks which will however soon run 
together and assume a dark-red or brownish colour, 
and the patches will assume all kinds of phantastie 
shapes of varying sizes, between which the normal 
skin is to be seen. The skin feels rough. 

In comparing the rashes of scarlet fever and that 
of measles, the former looks as if it had been painted 
on with the finest of camel's-hair brushes, the latter 
with an ordinary painter's brush. 

The course of the disease runs parallel to the 
development of the rash. The fever rises to and 
and stays at 104 degrees Fahrenheit or more. 



i92 THE CHILD IN HEALTH AND ILLNESS 

The child feels quite ill, it is listless, complains of 
severe headache and pains in its limbs; at night it 
may often be delirious. The symptoms which had 
been observed in the prodromal stage are all in- 
creased in intensity; the nose runs profusely, the 
discharge causing sores on the nostrils and upper 
lip; the inflammation of the eyes and the fear of 
light are more pronounced; the child is quite hoarse 
and croupy, and it suffers much from the continuous 
dry and painful cough. 

The tongue is covered with a heavy coat which 
comes off in pieces ; in the mouth one can see a red- 
ness in spots similar to those on the skin. 

Usually five or six days after the appearance of 
the rash the fever comes down suddenly, so as to 
be normal in from twelve to thirty-six hours ; at the 
same time all the symptoms improve and the child 
begins to play. 

German Measles 

Rubeola or German measles is a very benign ex- 
anthematous disease, the course of which is usually 
very light, so light in fact that it is frequently over- 
looked or attributed to an indiscretion in the diet. 

The disease is very contagious, but the disposition 
towards it seems to be only slight; children under 
two years of age and adults hardly ever catch it. 

The incubation is rather long, seventeen to twenty- 
one or more days. The prodromata are slight; the 
day before the appearance of the rash the child may 
feel chilly and tired and it may sleep badly. 



CONTAGIOUS DISEASES OF CHILDHOOD 193 

The rash begins as a rule in the face as light pink 
specks, the size of the head of an ordinary pin; it 
spreads in fits and starts, so that one part of the 
body will be affected while on another it has already 
faded; sometimes it runs together into larger spots 
but not as much as does measles; still, in some cases 
it may look very much like this latter disease; on 
other parts of the body again the spots may remain 
separated as in scarlatina. The rash will have dis- 
appeared entirely in from two to five days. Slight 
catarrh may accompany the rash and the tem- 
perature will be found to be a little above the normal. 
The disease runs its course in at most five days. 

Chickenpox 

Varicella is another infectious and very con- 
tagious exanthema ; it is almost always a disease of 
childhood and the human race is very prone to it. 
It spreads through the air and the contagion takes 
hold very readily; one attack confers usually im- 
munity for life. 

The incubation is long, not less than two weeks 
and sometimes more than three weeks. The rash 
appears usually without any prodromata; first 
small pink spots show on the head and the face ; some 
of these grow to the size of a lentil and form nodules, 
and then larger or smaller round blisters with clear 
contents. The eruption will then show up on other 
parts of the body in irregular distribution, leaving 
large parts of the skin free ; not all of the spots de- 



194 THE CHILD IN HEALTH AND ILLNESS 

velop into blisters, and we can observe, at one and 
the same time, all stages of the eruption on a small 
area of skin. 

The blisters lift up the uppermost layer of the 
skin; they have small compartments which are full 
of a yellowish liquid which at first is clear and later 
turbid. On their top they have a small indentation. 
They dry up into a brown crust which comes off 
without leaving a scar, except where the skin has 
been infected by scratching. 

The whole process from the appearance of a spot 
to the formation of the crust takes three days, but 
as the eruption comes in successive crops the disease 
may last two or three weeks. The fever is moderate 
and lasts three or more days. A few spots are 
usually found in the mouth and on the female gen- 
itals. 

In some cases the eruption is very intense ; every 
spot develops into a blister, and these are so closely 
together on the red and swollen skin that the case 
might easily be mistaken for one of smallpox by the 
laity, for whom the differentiation between these 
two diseases is by no means easy and who should 
therefore always call the physician for this pur- 
pose. 

Diphtheria 

Diphtheria is caused by the Klebs-Loeffler bacil- 
lus ; this may at times be found in healthy persons 
who are to all appearances well, the so-called diph- 
theria carriers, but who may and do transmit the dis- 



CONTAGIOUS DISEASES OF CHILDHOOD 195 

ease to other, susceptible, people. The bacteria when 
growing in infected people produce a poison which 
permeates into the body of the host and there acts 
in two ways, or better expressed it is composed of 
two poisonous substances, of which one seriously 
damages the blood-vessels, causes local inflammation 
and the poisoning of the whole system; the other 
one acts chiefly upon the nerves. The amount of 
this latter poison varies considerably in different 
epidemics. 

The clinical picture of diphtheria must be re- 
garded from two standpoints, namely, the local 
symptoms of the disease produced by the germs, and 
the poisoning of the body in general by the poisons 
produced by the germs in their growth. 

The bacteria usually gain entrance into the body 
through the nose, throat, and the upper air passages, 
though they may enter the body at other sites; the 
tonsils are most frequently the first seat of the 
attack. 

The inside of the mouth is red, the palate is also 
red though often in stripes ; upon one or both of the 
red and swollen tonsils we see a larger or smaller 
spot of a dirty greyish-yellow colour which upon 
closer investigation proves to be not in, but upon the 
tonsil. The local symptoms at this stage will fre- 
quently still be quite slight, and the child may even 
not complain of a sore throat. 

The sudden onset of the general symptoms, how- 
ever, will tell us that the child is quite ill. It com- 
plains of severe headache and of being sick in its 



196 THE CHILD IN HEALTH AND ILLNESS 

stomach, vomiting is usually present, and right f rom 
the very first it will be weak and exhausted. To- 
wards the end of the first or the beginning of the 
second day it will complain of its throat. 

During the next few days the membranes, for as 
such are the spots on the tonsils to be considered, 
spread over the tonsils and the soft palate; they 
assume a lighter colour and a silky sheen and they 
are not abruptly bordered toward their surround- 
ing. The glands in the neck and under the jaws will 
now begin to swell. In cases which have not had 
the benefit of the treatment with antitoxin the for- 
mation of the membranes will continue, until finally 
after five or six days the whole throat will be lined 
with membranes, and the disease will also go up into 
the nose. The child is now r very sick, it is apathetic 
and has no appetite, it is pale, wasted, and its loss 
of weight is considerable. 

In uncomplicated cases the process in the throat 
comes at last to a standstill, though it may progress 
in the nose for a few days more. The membranes 
are expelled in shreds of varying sizes or they may 
thin out gradually ; the fever which at first w T as fairly 
high comes down gradually and the temperature 
will be normal about the middle of the second week. 
The height of the fever does not correspond to, nor 
does it give any indication of, the severity of the 
disease in diphtheria. 

In infants the disease starts most frequently in 
one or both nostrils and it may remain confined to 
the nose altogether. 



CONTAGIOUS DISEASES OF CHILDHOOD 197 

From the foregoing sketch of diphtheria it will 
be seen how important it is to examine a child's 

throat every time it complains of being ill so that 
this dreadful disease is not overlooked in its be- 
ginning, when it can still be cut short, or at least 
its dangers lessened by the timely administration of 
antitoxin. 

Antitoxvn. Through the wonderful work of v. 
Behring, a German scientist, and Eoux, a French- 
man, we now possess a powerful specific antidote to 
the poison produced by the diphtheria bacillus in 
11 antitoxin.' ' 

When the system is being poisoned with a bac- 
terial poison, a toxin, it begins at once to prepare 
a substance, the antitoxin, which can unite with 
the poison, and thus form a new substance which 
is no longer poisonous; the antitoxin thus neutral- 
ises the toxin in a similar manner that an alkali will 
neutralise an acid by forming a salt which has an 
entirely different chemical action. 

In cases which recover of the disease the antidote 
has been produced in more than sufficient quantities 
to neutralise all the poison, and after the disease 
has been overcome we will still find considerable 
amounts of this antitoxin circulating in the blood; 
it is this surplus of antitoxin which will give the 
body some immunity, so that it can neutralise a cer- 
tain amount of toxin without showing any signs of 
illness, and also make the body an unfavourable soil 
for the growth of the bacillus. 

In preparing the antitoxin we make use of these 



198 THE CHILD IN HEALTH AND ILLNESS 

facts by gradually injecting increasing doses of the 
poison into animals, usually healthy horses which 
are well bred and fully grown; with this we continue 
until their blood carries enough antitoxin to neu- 
tralise many times the fatal dose of toxin. Some 
of the blood of the animal is then drawn ; it is tested 
as to its antitoxic properties, and preserved for 
use. 

The injection of this preserved antitoxin is now 
our principal treatment in cases of diphtheria. It 
is in reality a preventive measure in that it saves 
the system of the patient from further poisoning, 
thus giving the body a chance to repair the damage 
already done. 

It will, therefore, be readily understood that it 
should be used as early as possible, and it is 
now the practice among modern, up-to-date, scien- 
tific physicians to inject antitoxin in sufficiently 
large doses, even in suspicious cases, when they are 
first called to see a patient. Far better to give an 
injection of antitoxin once, when it was not required, 
than to wait until the most favourable time for its 
effect had passed. Statistics of hundreds of thou- 
sands of cases show that only when used during the 
first twentv-f our hours after the invasion bv the bac- 
teria will the antitoxin exert its full benefit. The 
injection of the antitoxin can be done in a few sec- 
onds without much pain and its beneficial effect is 
wonderful while the dangers from the injection are 
very small. 

Xot to give antitoxin is, in the writer's opinion, 



CONTAGIOUS DISEASES OF CHILDHOOD 199 

criminal neglect. Physicians who are still rof raili- 
ng from using this most beneficial remedy, — one of 
the few true specifics which we possess — or who still 
ire waiting for a report from the bacteriologist, 
vvhich means a delay of twenty-four hours or more 
3efore administering it, or those who still make a 
liagnosis of kk membranous croup, " which is always 
diphtheria, are filling the grave-yards with the un- 
timely victims of their ignorance and conceit, when 
thev could have saved many a one of their little 
patients by the timely administration of one of the 
greatest discoveries ever given to mankind for the 
fight against a dreadful disease. 

For parents to deny their child this remedy on 
account of some foolish notion or some preconceived 
ideas is, to say the least, inhumane. 

"Whooping cough 

Pertussis or whooping cough is an infectious dis- 
ease, the cause of which has been found recently. It 
is epidemic and starts usually from schools, orphan 
asylums, etc., and it is also frequently spread from 
summer resorts frequented by children. It is a 
very common disease which in the cities few chil- 
dren escape. It is transmitted from man to man, 
as the germ does not live long outside of the body* 

The disease begins with a catarrhal stage, during 
which it is impossible to make a correct diagnosis, 
except in times of an epidemic, because it is not at 
all characteristic. The child seems to suffer from 



200 THE CHILD IN HEALTH AND ILLNESS 

an inflammation of the windpipe or the bronchial 
tubes, with sometimes slight fever. This lasts for 
about two weeks and then the child begins to de- 
velop the typical attacks of coughing which show 
that it has entered the second, spasmodic, stage. 

In one of these attacks the child will have a severe 
cough without intermission for about thirty seconds 
or more, so that it gets blue in the face from lack 
of air; the attack is accompanied by the expectora- 
tion of copious sputum and it ends frequently with 
vomiting. As children under seven years of age 
hardly ever expectorate except in this disease this 
is frequently an aid in the diagnosis. Between the 
attacks the child may be to all appearances entirely 
well and it has no fever. 

The number of these attacks in tw^enty-four hours 
determines the severity of the disease, as frequent 
attacks may w r eaken the child considerably, and as 
the frequent vomiting may seriously interfere with 
its nutrition. 

The face of the child will soon be more or less 
bloated, from the congestion of blood during the at- 
tacks of coughing, and in the eyes w r e may observe 
bleeding; in children with teeth w r e frequently find 
a sore under the tongue from chafing during the 
cough. 

The number of the attacks may vary considerably, 
and it may reach fifty or even more in tw r enty-four 
hours; their number increases rapidly in the spas- 
modic stage and reaches its maximum in from ten 
to fourteen days; they remain at their height for 



CONTAGIOUS DISEASES OF CHILDHOOD 201 

from four to six weeks, and they then diminish 
slowly until finally nothing is left but a loose cough 
which will last for some time longer. 

Mumps 

The inflammation of the salivary gland in front 
and under each ear is caused by an unknown germ; 
it is contagious, and appears in epidemics. 

After a stage of incubation, lasting from eighteen 
;o twenty-two days, the child will feel sick for from 
one to three days, without showing any characteris- 
ic signs. Then the gland described above, the paro- 
;id gland, begins to swell, and it will now be quite 
easy to recognise the nature of the disease by the 
typical appearance of the face. The swollen parts 
feel doughy and the skin over them is tense and 
shiny though rarely reddened. This swelling and 
the irregular fever which accompanies it last for 
from three to seven days. The child suffers only 
from the local pain and the inconvenience of the 
mechanical interference with the opening of the 
mouth. 

Usually the course of the infection runs smoothly ; 
the child frequently does not feel even sick enough 
to stay in bed, and the disease will not leave behind 
it any disturbances. 

Acute Articular Eheumatism 

Inflammatory rheumatism is rare in the first half 
of childhood ; it is always a serious disease, no mat- 



202 THE CHILD IN HEALTH AND ILLNESS 

ter how light it may appear to be, owing to its lia-l 
bility to recurrences ; any person who has once had 
an attack is almost sure of having one or more at 
some time or other during life ; nor are we able to 
foretell at which one of these the most dreaded and 
dangerous complication of this infection, inflamma- 
tion inside the heart, will develop. 

Quite frequently we have as a prodrome an attack 
of tonsillitis or only the indefinite symptoms of gen- 
eral languor and dragging pains in the joints; then 
the temperature rises suddenly to 104 degrees Fah- 
renheit or higher, and at the same time the child com- 
plains of severe pain in one or more joints, which 
we find swollen at examination; the first joints to be 
affected are usually the feet or knees; the disease 
rapidly involves other joints in quick succession, 
and when new joints are attacked the inflammation 
in those previously involved recedes as a rule. In 
severe attacks one and the same joint may be in- 
volved repeatedly. The attacks in an individual 
joint will usually last only a few hours. The tem- 
perature is generally irregular and the attack upon 
a new joint is often accompanied by a rise in the 
fever. 

The child suffers a great deal from the pain and 
its countenance is distressed, the tongue is coated, 
the bowels constipated, the thirst is severe and tor- 
menting, the child has no appetite and suffers from 
insomnia. The pallor of the skin is most marked. 

In uncomplicated cases and under proper treat- 
ment improvement will usually set in by the end of 



CONTAGIOUS DISEASES OF CHILDHOOD 203 

the first week, but great precautions have to be em- 
ployed to prevent relapses. 

Light attacks of this disease may be observed by 
no means infrequently. Those cases, being unac- 
companied by fever or any general symptoms, and 
manifesting only vague pains in the body, are usu- 
ally not recognised and pass by the name of "grow- 
ing pains" ; but their true nature should not be for- 
gotten and the physician should always be consulted. 

One form of the rheumatic infection which is gen- 
erally not recognised as such and which is really 
more frequent in childhood after the fourth year of 
life than the form affecting the joints is St. Vitus ' 
dance or chorea minor. 

Sometimes the child may have prodromata, it is 
cross and out-of-sorts, complains of headache, has 
pains and weakness in the limbs, it tires easily. In 
most cases, however, the disease starts suddenly 
with peculiar movements of groups of muscles, 
mostly in the face, neck and upper extremities, which 
closely imitate co-ordinated motions and which ap- 
pear to be voluntary though they are entirely in- 
voluntary. 

The child twists its shoulders in a peculiar man- 
ner, like a Frenchman expressing doubt ; it points its 
lips as for whistling; it puts out its tongue and 
pulls its mouth to one side; it grins, grinds its 
teeth, frowns, etc. ; the movements in the hands and 
arms are observed especially in occupations de- 
manding a considerable amount of co-ordination, 
like sewing or writing; here we observe sudden, 



204 THE CHILD IN HEALTH AND ILLNESS 

jerky motions which interfere with these functions; 
the disease may also make it impossible for the child 
to keep its muscles in a particular position for any 
length of time; it will drop a thing it holds in its 
hand without any apparent reason; it cannot sit still 
in school and fidgets around in its seat and twists 
its body in all directions. All these motions seem to 
be voluntary, and for some time they may be con- 
sidered as bad habits and naughtiness; the child is 
consequently rejDroved or punished, and this as well 
as the teasing of its school-mates makes the condi- 
tion worse. 

The speech will also be affected, the child will 
pause in the wrong place, its speech will be low with 
a wrong intonation, explosive and at times with a 
mixing of letters. 

When the lower limbs are affected the child will 
step with one foot upon the other, stand on its toes, 
and finally standing and walking may be impossible. 

In light cases the sleep w T ill not be interfered with 
and the motions will then cease ; in severe cases the 
motions will no longer look voluntary but they will 
be convulsive ; the child throws itself around in bed, 
hitting out with hands and feet, and the bed has to 
be padded to prevent injuries. 

Epidemic Cerebrospinal Meningitis 

Brain fever is an infectious disease of childhood, 
inasmuch as ninety out of every one hundred cases 
occur in children, and of these twenty-five in infants. 



CONTAGIOUS DISEASES OF CHILDHOOD 205 

The disease is of an epidemic nature and it is 
caused by a known germ which is sometimes found 
in the nose of healthy persons; its virulence for the 
human race is not very great and it seems to require 
a special disposition in order to produce the dis- 
ease; this explains the comparative rarity of the 
disease. 

After a few indefinite prodromal symptoms, or 
sometimes without these, the child is suddenly taken 
very ill with high fever, severe headache, great rest- 
lessness interrupted by cries from pain, vomiting, 
and within twenty-four hours the most characteris- 
tic symptom, rigidity of the neck ; the head is drawn 
back into the pillow, the spine is arched forward 
and is stiff; every attempt to move the head is very 
painful and therefore strongly resisted. All the 
nerves are in a condition of extreme irritability; 
the lightest touch may be resisted as unpleasant or 
even cause pain, likewise strong light or a loud 
noise, and the child is worried every time some- 
body approaches the bed. The severe pain greatly 
interferes with the patient's rest. The colour of the 
skin changes rapidly and the lightest touch may 
cause a persistent redness as from a blow. Vomit- 
ing is always a prominent sign; it is of nervous 
origin and very refractory to treatment. Diar- 
rhoea is frequent and severe. The appetite is en- 
tirely absent. The duration of the disease is usually 
from four to six weeks. In infants we observe often 
rapid cases which end fatally in three or four days. 

This disease is always a very grave one and only 



206 THE CHILD IN HEALTH AND ILLNESS 

after the acute symptoms will have subsided can we 
form a judgment of the damage really done. 

Infantile Paralysis 

This disease has only quite recently been prop- 
erly classed among the acute epidemic infections 
of childhood, and the germ causing it, which is 
perhaps the smallest known so far, has been found 
lately by Professor Plexner at the Rockefeller 
Institute. 

The disease has been known for some years but 
of late years it has appeared in an epidemic form 
in this and other countries ; it seems also to be get- 
ting more frequent, but by no means so much as to 
call for the almost hysterical excitement w r hich pre- 
vails as soon as the finding of one case is announced 
in a localitv. 

m 

It begins with high fever wdiich usually lasts for 
from one to three days; constipation, restlessness, 
which may be increased to convulsions, cloudiness of 
the mind with sleepiness are the principal symp- 
toms ; older children complain of headache and pains 
in the limbs. 

After the disappearance of these acute symptoms, 
from which the physician is only in rare instances 
able to make a correct diagnosis, more or less ex- 
tended paralyses in one or more parts of the body 
will be found to exist. This paralysis is at its height 
immediately after the acute symptoms, and it will 
frequently recede to a greater or lesser extent in the 



CONTAGIOUS DISEASES OF CHILDHOOD 207 

course of a few days, weeks or months. Treatment 
of the paralysed parts should be begun not earlier 
than three weeks after the cessation of the acute phe- 
nomena, and should be persisted in for many months 
before the hope for ultimate restoration of the func- 
tion can be relinquished. 

Tuberculosis 

The infection with the tubercle bacillus is the 
most frequent one to which the human race is prone, 
but luckily a child will not suffer from the disease 
tuberculosis, in one of its many forms, every time it 
takes these germs into its system. 

In infants and small children the infection may 
take one of two roads, either through the respira- 
tory tract, by inhaling infected material, as dust or 
in droplets, or through the digestive tract, by swal- 
lowing infected material. It is by no means neces- 
sary that the disease should start at the site of the 
entrance of the germs into the body, nor is it neces- 
sary that the entrance of the germs should cause at 
once any definite symptoms or any well-defined dis- 
ease. In infants the infection with the tubercle ba- 
cillus seems to be almost always fatal, but in older 
children the bacilli may either die or they may be 
stored up in some part of the body, perhaps in some 
gland, to stay there without doing any damage for 
the rest of the child's life, or it may come out of 
its hiding-place, owing to some cause, and then start 
its ravages. 



208 THE CHILD IN HEALTH AND ILLNESS 

The most frequent types of tubercular disease in 
children are affections of the glands in the neck and 
inside the chest, meningitis, peritonitis and disease 
of the bones and the joints, while the infection of 
the lungs, which is the usual type in adults, is per- 
haps less prominent, though by no means rare. 

That tuberculosis is a curable disease is proven 
by the fact that after the second year of life most 
children show by special tests that they have been 
harbouring, or are still harbouring, the germ in 
their system. 

Children of certain types are more apt to suffer 
from tubercular diseases than others, namely, those 
of the so-called torpid type and those of the erethic 
type. The former are the children who seem to be 
well nourished ; they are stout, but on close examina- 
tion it will be found that they are really water- 
logged, that their muscles are poorly developed, 
their fat and skin flabby, they are pale and anemic. 
The latter are the slender children with pale skin 
and a beautiful complexion, who change their colour 
very rapidly, and in whom the slightest injury is 
liable to leave long-persisting red blotches in the 
skin; many of these children have long silky eye- 
lashes and hair, and they have considerable hairi- 
ness between the shoulder blades ; they are usually 
very bright, are nervous and very susceptible to cli- 
matic changes. It is obvious that proper treatment 
and especially hygienic measures will be able to 
ward off the impending clanger in many of these 
cases. 



CONTAGIOUS DISEASES OF CHILDHOOD 209 

THEIR COMPLICATIONS 

The contagions and infectious diseases described 
in the foregoing pages menace the child's life and 
health, not only by the poison formed by the bacte- 
ria causing these diseases, but also render the child 
susceptible to accidental infections, or cause such 
changes in some or several of its vital organs as 
may still further add to these dangers, so that even 
the most experienced physician when approaching^ 
the bedside of a child sick with one of the infectious 
diseases, no matter how light the attack may appear 
to be in the beginning, can never foretell if the 
course of the disease will be an uncomplicated one, 
or if one of the dreaded complications may not set 
in at any time during the course of the illness, or 
after it has seemingly run its full course. 

Some of these infectious diseases are more apt to 
be accompanied by complications than others. 
Thus, for instance, scarlatina and diphtheria are the 
two diseases most to be dreaded for this reason r 
while chickenpox and German measles are only 
rarely aggravated in this way. 

Again, it may also happen that two infectious 
diseases attack the child simultaneously, and this 
may add considerably to the danger for the little 
patient's life, as for instance if he were to suffer 
from both scarlatina and diphtheria at one time or 
in quick succession. 

Some of the complications are preventable, others 
are not. When speaking about the prevention of 



210 THE CHILD IN HEALTH AND ILLNESS 

these diseases we have shown that the state of health 
of the child at the time it takes the infection into 
its system is of the utmost importance as to the ul- 
timate outcome, and we know that for some of these 
diseases the social condition of the parents, which 
determines to a large extent the hygienic surround- 
ings of the patient, plays an important role ; for in- 
stance, measles and whooping cough are compara- 
tively innocent diseases in the houses of the well-to- 
do, while in the slums they will frequently assume 
a most pernicious type, and this for the reason that 
the dreaded pneumonia which is the most frequent 
complication in these two diseases is not part of the 
infection itself, but is due to the additional and acci- 
dental infection with grippe, which is very difficult 
to prevent, not only in the crowded tenements but 
also in hospital wards, no matter how sanitary they 
may be. Tuberculosis of the lungs which also fre- 
quently follows both these diseases is, naturally, 
oftener found in the quarters of the poor and where 
the children are not watched and tended with the 
tender care they require. 

We will now proceed to describe the most fre- 
quent complications in infectious diseases, so that 
the mother will know what she may have to expect, 
that she will always carry out the physician's orders 
to the very last letter, and that she may understand 
why some of these orders were given. 

In diphtheria we can observe almost in every case 
symptoms from the throat due to the original in- 
fection. These may be so severe as to occlude the 



CONTAGIOUS DISEASES OF CHILDHOOD 211 

air passages almost entirely and to necessitate the 
making of an artificial passage for the air, either 
by inserting a special tube into the throat, intuba- 
tion, or by opening the throat from outside with the 
knife and placing a tube through the wound, 
tracheotomy. 

In scarlatina the inflammation of the throat, 
which is here also in most cases a part of the orig- 
inal infection, may be complicated by an accidental 
infection with the germs of blood-poisoning, which 
may produce the most dangerous conditions. In 
both diseases the glands under the jaws and in the 
neck will be swollen from this infection and they 
will form big masses which may lead to the forma- 
tion of abscesses later on. 

The bacteria in scarlatina, the accidental grippe 
infection in measles and the diphtheria bacilli in 
the nasal type of this disease, may at any time 
ascend into the middle ear through the passage from 
the back of the mouth into the ear, the so-called Eu- 
stachian tube, there to cause severe inflammations 
which may eventually destroy the hearing of one or 
even both ears. 

The heart is sure to be affected by any infectious 
disease, but the poison produced by the diphtheria 
bacillus has a predilection for this organ and will 
leave it in such a condition that a slight exertion, 
even after the disease itself has been successfully 
overcome, may lead to permanent damage of this 
important organ if not to its sudden failure; for 
this reason the careful physician will insist upon 



212 THE CHILD IN HEALTH AND ILLNESS 

the little patient being kept on its back for some] 
time during convalescence. In septic cases of scar- 
latina the heart will also suffer severely oftentimes, 
and in inflammatory rheumatism involvement of 
the heart is notoriously frequent and much to be 
dreaded because it causes permanent invalidism in 
so many cases. 

The kidneys are most frequently damaged by the 
poison of scarlet fever, but measles, diphtheria and 
even chickenpox may leave these organs in an im- 
paired condition which may result in permanent 
trouble; for this reason the diet during the con- 
valescence from these diseases has to be carefully 
watched ; the patient must stay in bed for some time 
after the disappearance of the symptoms of the dis- 
ease and the urine must be examined by the phy- 
sician at frequent intervals ; in scarlatina daily, for 
some time. 

The appetite is often very poor after some of 
these diseases, especially after diphtheria and also 
after scarlatina, and it is at times extremely diffi- 
cult to feed these children with a diet which is nour- 
ishing and at the same time suitable. 

The genital organs may be affected by a swelling 
and pain in mumps, though this will rarely leave 
any permanent damage in these organs. 

Regulation of the bowels is one of the most diffi- 
cult, and at the same time one of the most impor- 
tant, tasks during and after an infectious disease. 

After diphtheria we may observe paralyses of 
the muscles for swallowing or of the eyes and also 



CONTAGIOUS DISEASES OF CHILDHOOD 213 

of other muscles; these require long-continued care- 
ful treatment. 
In scarlet fever we may observe an inflammation 

of the joints, which adds greatly to the suffering of 
the patient. 

These are some of the complications which we see 
most frequently and for which we should always be 
on the lookout; many more could be mentioned, but 
we will leave their explanation to the physician 
rather than to create any unnecessary fear in the 
minds of the laity. 

THEIK CAKE 

The Sickroom. Whenever this is possible, the 
choice of the room for the patient should be left to 
the physician and the nurse. All considerations 
other than the welfare of the patient should be re- 
garded as secondary, even if the rest of the family 
should have to suffer some temporary inconven- 
ience. The room should be chosen as far away from 
the quarters of the family as possible but near a 
bathroom. 

The largest and airiest room in the house is just 
good enough; where the circumstances permit of 
this, two adjoining rooms should be set apart, so 
that indirect ventilation can be carried on, and 
when the patient is convalescing he can occupy one 
room in daytime, the other at night. 

All carpets, curtains, hangings? pictures and up- 
holstered furniture should be removed from the 



2i 4 THE CHILD IN HEALTH AND ILLNESS 

room, and only such pieces of furniture should re- 
main in it which can be washed easily, or which may 
be destroyed without any great pecuniary loss. 

The hallway leading to the sickroom or the door 
of the room itself may be protected by a sheet kept 
moist with some antiseptic solution; this may not 
help very materially to prevent the spread of the 
infection, but it will at least serve as a reminder for 
the rest of the family to keep out of this room. 

The Bed. The best bed in which to take care of 
any sick person is a so-called hospital-bed, a high, 
single, white enamelled iron bed, best with a back- 
rest which can easily be elevated by turning a crank 
(see Fig. 57). The bed should stand free on all sides, 
so as to make the patient readily accessible for all 
ministrations without its being necessary to move or 
otherwise disturb him. It should be placed in one 
corner of the room so as to keep the patient out of 
the path of the direct air-currents between the door 
and the open window. In measles the bed should be 
protected by a screen against bright light, because 
the eyes are rather sensitive in this disease; but it 
is by no means necessary nor wise to darken the 
room entirely, as is still done quite frequently. 

The mattress should be hard and must be pro- 
tected by a piece of rubber-sheet, the pillow also 
should be hard and likewise protected, though it is 
best to burn this after the patient has recovered, 
since it is usually soiled by the discharges from the 
nose and mouth; in some diseases, as for instance 
scarlet fever and diphtheria, the mattress is also 



CONTAGIOUS DISEASES OF CHILDHOOD 215 

lest burned when the patient is past the danger of 
infecting anybody. 

The bed-covering should be light and warm, and 
only such blankets as can be washed and disin- 
fected must be used. Featherbeds or quilts should 
therefore not be used. 

The undersheet on the bed should be pinned down 
at all four corners so that it will not wrinkle ; under 
the child's buttocks should be a drawsheet which 
can be changed when soiled without changing the 
undersheet. 

All articles used in the sickroom, such as sheets, 
pillow-cases and towels, must be soaked in an anti- 
septic solution in the sickroom, and they should be 
washed separate from the family washing. 

Dishes. Outside the room occupied by the patient 
should be placed a table w\here all food for the pa- 
tient and his nurse should be deposited. All dishes 
used by the patient, as well as his spoons, glasses, 
cups, etc., must remain in the sickroom and must be 
washed there. 

The attendant should never touch food or drink 
inside the sickroom, but should eat either at the 
table in the hall or in a second room. 

Excreta. Expectorations, nasal discharges, dis- 
charges from the eyes and ears, and the pus from 
ulcers and sores, etc., should be collected in pieces 
of absorbent gauze which should be placed in paper- 
bags and burned at once. Urine and stools must 
be disinfected with chloride of lime or crude car- 
bolic acid, in both of which they should remain 



216 THE CHILD IN HEALTH AND ILLNESS 

for at least one hour before being deposited in the 
toilet. 

Food. In all infectious diseases it is best to give 
the patient a diet of milk and cereals, at least in 
the beginning; later on it should be left to the in- 
genuity of the physician, who may have reasons for 
ordering special diets as indicated by the nature of 
the case. 

The Patient. The skin of the patient must be 
kept clean by bathing or sponging with luke-warm 
water at least twice a day, and not even measles, 
in which disease the effect of water is most dreaded 
by the laity, should form an exception. "When the 
fever is high the physician may order sponge-baths 
for its reduction. 

The eyes should be w r ashed with some mild anti- 
septic solution morning and evening; in measles and 
scarlet fever some mild ointment should then be 
applied. 

The mouth must be rinsed out frequently with 
some mild tasty solution, in scarlet fever and diph- 
theria at least six or eight times a day. 

The nose should be swabbed with moist or greased 
cotton swabs, and the nostrils and upper lip should 
be covered with some mild ointment to prevent their 
getting sore from the nasal discharge. 

In those diseases in which scaling takes place it is 
advisable to grease the skin to prevent or diminish 
the itching. 

During the acute symptoms of any. one of these 
diseases the patient must be kept in bed as quietly as 




Figure 57. hospital bed 




FlOT'RE F)S. wool truss 



CONTAGIOUS DISEASES OF CHILDHOOD 217 

possible and all excitement must he avoided; but 
even after these symptoms have subsided it may be 
advisable in many eases to keep him still further in 
bed, for a longer or shorter period, and this is the 
most trying time for the nurse, who must do her 
utmost in entertaining him so as to make this seem- 
ing hardship, the reason for which he can not un- 
derstand, lighter for him. He may then be allowed 
to have simple play-things which do not require any 
exertion and which can be readily destroyed or 
disinfected. 

Disinfection. When the physician has decided 
that all danger of carrying the infection is passed, 
and that it is safe to let the patient rejoin the fam- 
ily-circle, he should be given a final full bath and a 
shampoo, be given clean clothes which have not been 
kept in the sickroom, and he is now able to get 
out once more. 

The nurse must now disinfect the room, if this is 
not to be done by people specially trained in this 
and under the supervision of the health-authorities ; 
she then takes a bath and a shampoo herself, changes 
her clothing and she can once more mingle w r ith the 
outside world. 

In case the mother should undertake the nursing 
of her child herself and should have to tend to her 
household duties at the same time, she must be ex- 
tremely careful so that she will not carry the dis- 
ease to other members of the familv; she should 
have a special gown to wear in the sickroom only, 
which she removes before entering the other parts 



218 THE CHILD IN HEALTH AND ILLNESS 

of the house; she must also always carefully wash 
face and hands on leaving the patient. 

The careful, up-to-date physician will bring a long 
gown when he first visits a case of an infectious 
nature; this he leaves at the door of the sickroom, 
and he always puts it on before he sees his patient; 
this gown remains in the house and is returned to 
him washed when it is no longer needed. 

In all cases of infectious diseases all orders of 
the physician's should be carried out most assidu- 
ously and without any question ; it is he who has to 
take the full responsibility and he should never be 
hampered in his earnest efforts to do anything and 
everything that he considers best for the patient in 
his charge ; nor should any member of the family or 
any outsider be permitted to decry his efforts at 
preventing the spreading of the disease as new- 
fangled fads. The mother and nurse must make it 
clear to the little patient that the physician is his 
friend and that his directions must be obeyed, no 
matter how irksome. Then, and then only, can the 
physician do his very best for his patient and the 
result will be accordingly. 



CHAPTER XV 
OTHER DISEASES OF CHILDHOOD 

IN comparison with the infectious and contagious 
diseases of childhood all other diseases or ail- 
ments will seemingly dwindle in importance, yet 
those disturbances of the normal function of differ- 
ent organs, or parts of the body, are by no means 
infrequent and, therefore, deserve mention. 

These abnormal conditions may be due to mal- 
formations brought into the world, or they may be 
due to inherited tendencies, or finally they may 
arise from external causes, and they may then be 
traceable to an antecedent infection, though it may 
be very difficult at times to prove this dependency. 

It can naturally not be within the province of a 
book like this to go into detail about all these 
disorders, and the writer will therefore give only a 
brief survey which will indicate to the mother what 
the nature of any given illness might be, what she 
has to expect, and when it will be necessary for her 
to call on the physician for his advice. 

DISEASES OF THE BLOOD 

In infancy and early childhood anemia of some 
form or other may be observed quite frequently. 

219 



220 THE CHILD IN HEALTH AND ILLNESS 

This may be due to wrong feeding, and will then 
yield readily to a change in the diet, but it may| 
also be dependent upon other and more serious 
causes, and it may even take on a very grave aspect. 

The physician will not be able to make a correct 
diagnosis of these conditions if he is not given the 
opportunity to take a sample of the patient's blood 
for examination. This examination of the blood will 
give him an insight into the cause of the anemia and 
will tell him which part of the blood is at fault and 
where, consequently, his efforts at curing the patient 
should be directed; but it may also be of inesti- 
mable value to him in other conditions, as for in- 
stance in appendicitis, when it will tell him if an 
immediate operation is demanded, or in other 
chronic conditions in wdiich this examination will be 
the means of clearing up a case which was other- 
wise enigmatical. 

During the school-age we observe many cases of 
anemia which arise in children after they have at- 
tended school for some weeks and which disappear 
again during vacation time. Naturally this condi- 
tion is found mostly in children who have been 
weakly, but apparently healthy children may also 
be thus affected. This school-anemia is due prin- 
cipally to three causes : First, bad feeding, as these 
children frequently do not take the time for break- 
fast; some children even get sick at the sight of 
breakfast and they may suffer from the so-called 
school-vomiting; if they go home for lunch the time 
will usually be far too short for this meal and they 



OTHER DISEASES OF CHILDHOOD 221 

must therefore bolt it, or if they take their lunch 
with them to school they have to be satisfied with a 
cold meal, which, at that, is frequently not well 
chosen, consisting often of too much sweets; and in 
the evening the child will in many cases be too tired 
for dinner. The second cause is the change in the 
mode of living, when a child who has spent most of 
its time in outdoor play has to remain many hours 
of each day in a sitting posture in the air of the 
schoolroom which is usually bad. Finally, the third 
cause is found in the psychic factor, a disturbance 
of which reacts only too frequently upon the health 
of a high-strung child. 

The treatment of these school-anemias is obvious, 
though the physician must, naturally, determine first 
if this is really the true nature of the trouble. A 
step in the right direction towards the prevention 
of this condition is taken in the open-air schools, 
where the children are given a substantial lunch; 
but their number is still far too small though they 
now are well past the experimental stage, and too 
many of these are reserved for the children of the 
wealthv. AYeaklv children, or those in whose fam- 
ilies a tubercular taint can be found, should, wher- 
ever possible, receive their education in one cf these 
open-air schools. 

In certain families, of so-called bleeders, we find 
an insufficient coagulability of the blood which may 
lead to serious and even fatal hemorrhages from 
slight injuries. This condition is transmitted 
through the female line, though it appears usually in 



222 THE CHILD IN HEALTH AND ILLNESS 

males. These children must be guarded carefully 
against injuries and whenever they are taken to a 
physician or to a dentist this condition should be 
called to his attention to avoid serious complica- 
tions of an otherwise slight operation, thus as the 
pulling of a tooth or the removal of adenoids or 
enlarged tonsils. 

DISEASES OF THE HEAKT 

When speaking of the infectious diseases of child- 
hood we have seen that many of these, especially 
inflammatory rheumatism, frequently leave the 
heart in a seriously damaged condition by interfer- 
ing with the opening or closing of its valvular appa- 
ratus, while others, such as diphtheria, attack the 
muscles of the heart. Again the outer covering of 
the heart, the pericardium, may be affected, and 
this will naturally interfere with the movements 
of the heart. 

Xot infrequently a child may be born in which the 
development of the heart may have been arrested 
at some stage, or in which the closure of the open- 
ing between the two sides of the heart, which nor- 
mally takes place during the first few days after 
birth, fails to materialise, or a child may suffer from 
a disease affecting its heart even before birth. 
These are either the so-called blue babies, in whom 
the skin may have a bluish-black colour from the 
very time of their birth, either all the time or only 
when they cry or otherwise exert themselves, but 



OTHER DISEASES OF CHILDHOOD 223 

in many of these cases the condition will pass un- 
recognised until the physician accidentally discov- 
ers it. In the severer cases the condition will lead 
to an early death; the lighter cases may live for 
years, especially when they have been taught to 
avoid all physical exertions and to choose a seden- 
tary occupation. 

DISEASES OF THE RESPIRATORY ORGANS 

Coryza. No ailment is more frequent in child- 
hood than the so-called "cold in the head" or coryza. 
But while it is a serious disease when occurring in 
infants, as we have seen before, it is in older chil- 
dren a comparatively mild disturbance, and only if 
it should occur frequently will it be deserving of at- 
tention, because it may then become chronic and its 
consequences may cause permanent trouble. 

Coryza is an infection of the inner lining of the 
nose, and its transmission is readily accomplished 
from one person to another; though it is usually 
favoured by sudden changes in temperature and by 
chilling from wet feet, or the sojourn in a cold damp 
place and like exposures, still any of these expo- 
sures will never lead to a coryza if the means for 
an infection are not present at the same time. 

We can observe two types of this infection which 
vary considerably in the severity of their symptoms. 
In one the anterior part of the nose only is affected, 
and the symptoms caused by this are rather slight ; 
the child is as a rule cross and cries easily, it has a 



224 THE CHILD IN HEALTH AND ILLNESS 

Blight rise in the temperature, it sneezes, has run- 
ning eyes and nose. In from four to six days the 
trouble is usually past. Not so the second form, 
which affects the posterior parts of the nose as well; 
in this we observe fever, which may be quite high, 
and the nasal discharge may be profuse and cause 
sores on the upper lip. The child suffers consider- 
able discomfort from the occlusion of the nose, a 
feeling of dryness and irritation in the throat which 
is responsible for a constant hawking. This is the 
infection which leads so frequently to an infection 
of the middle ear and which is also liable to descend 
into the deeper air-passages. 

Adenoids. At the junction of the cavities of the 
nose and the mouth in front of the spine is located 
some lymphatic tissue, similar to that which forms 
the tonsils; this so-called third tonsil is especially 
large in children with a peculiar "lymphatic" con- 
stitution, but from the irritation of repeated attacks 
of posterior coryza and especially from the infec- 
tion in cases of chronic inflammation it may grow to 
so considerable a size as to interfere seriously with 
the normal nose-breathing, and also to occlude the 
opening of the Eustachian tubes. The result of this 
is seen in the peculiar expression in the faces of 
these children, who keep their mouths open habitu- 
ally and who will also have a deformity of the hard 
palate with a protrusion of the middle incisor teeth 
and a flattening and broadening of the bridge of the 
nose, which makes a diagnosis of adenoids at one 
glance so easy to the initiated. 



OTHER DISEASES OF CHILDHOOD 225 

These children suffer frequently from a persist- 
ent irritating cough, due to the fact that the air 
which has not been filtered, warmed and moistened 
by its passage throngh the nose, as in normal breath- 
ing, irritates the throat, especially in the evening 
on going to bed and at night ; during sleep the saliva 
will also run out of the open mouth and form the 
characteristic sores in the corners of the mouth and 
will also leave the telltale spots on the pillow. The 
child sleeps badly, it snores, is liable to nightmares, 
its appetite is poor, its voice is nasal, and its hear- 
ing may be considerably impaired; teachers now 
frequently make the diagnosis of adenoids when 
otherwise bright children begin to be backward in 
their lessons. 

The treatment of this condition consists in the re- 
moval of the adenoid growth, a comparatively slight 
operation, the effect of which, when not done too 
late when permanent damage has already been done, 
is often marvellous. In children with the lymphatic 
constitution we can frequently prevent the develop- 
ment of adenoids by a proper strict regime and diet. 
Naturally any chronic infections of the nose should 
be treated energetically and the child should be 
guarded against infection with coryza. 

Angina. At certain times of the year we will ob- 
serve infections of the throat in the form of small 
family epidemics, and from the second or third year 
of life no infection with pus-producing germs is 
more frequent than those of the soft palate and the 
tonsils. 



226 THE CHILD IN HEALTH AND ILLNESS 

The lining of the soft palate and the tonsils will 
be found on inspection to be deep-red and swollen, 
though this is not easy in children who have not been 
trained to having their throat examined ; then, later, 
we will see the tonsils to have white stripes upon 
them and in their folds or they will be studded with 
yellow cores; these are the two principal forms of 
tonsillitis. 

The symptoms of this inflammation, the so-called 
angina, are always severe, the child is quite dull, it 
complains of headache and wants to go to bed, it 
may vomit, beginning with chills, the temperature 
may rise rapidly, swallowing is painful and diffi- 
cult, often so much so that the little patient refuses 
to take food and medicine, the voice is thick, the se- 
cretion of mucus is considerable, the glands under 
the jaws are swollen and painful. The disease lasts 
about a week with continuous high fever. 

Appendicitis is a frequent sequence to this dis- 
ease and this is surely more than a mere coincidence ; 
the same is the case with inflammatory rheumatism. 
In some cases, though not as frequently as happens 
in adults, the infection may lead to the formation 
of an abscess in the tissues surrounding the tonsil, 
so-called quinsy. In young children it may cause 
an abscess in front of the cervical spine, the retro- 
pharyngeal abscess. The infection of the glands un- 
der the jaw may dominate the picture and the in- 
fection in the palate and tonsils may be so slight 
as to be entirely overlooked, then we will observe 
swelling of these glands as well as of those down 



OTHER DISEASES OF CHILDHOOD 227 

the neck; this condition usually lasts for several 
weeks and has been called "glandular fever." 

Diseases of the Throat. An inflammation of the 
throat is a frequent accompaniment of coryza. This 
affection may either be very light, only a superficial 
inflammation with hoarseness and secretion of tough 
mucus which becomes loose very quickly, or we may 
observe a severe inflammation of the throat which 
will be the more dangerous the younger the child, 
because in young children the throat is naturally 
comparatively narrow and any severe inflammation 
can readily interfere with respiration ; in this latter 
form the throat and the windpipe are both quite 
sensitive to slight pressure. 

In both these varieties of so-called laryngitis we 
observe the attacks of pseudo-croup, which we have 
already described under the diseases of infants. 

When these attacks of laryngitis are frequently 
repeated — and some children are very prone to this 
disturbance — we may observe chronic hoarseness 
which will necessitate long-continued treatment, best 
with change of climate. 

Tubercular ulcers in the throat are not infrequent 
in children. Occasionally we will also observe cases 
in which the inside of the throat is more or less 
studded with small wart-like growths which may 
seriously interfere with respiration and which will 
make the child almost voiceless; the treatment of 
these is surgical, though they recur very easily. 

Diseases of the Windpipe and Bronchial Tubes. 
Inflammation of the windpipe, tracheitis, is one of 



228 THE CHILD IN HEALTH AND ILLNESS 

the most frequent and, if taken in hand in time, one 
of the lightest affections of childhood, especially at 
the school-age. 

This grippy infection begins with headache, chilli- 
ness, lassitude, restlessness, and lack of appetite, 
the fever is rather high for a day or two, and an 
inflammation of the nose and throat has preceded it 
by some days. The child complains of a raw, burn- 
ing sensation behind the upper part of the breast- 
bone. Cough is the principal symptom; this is at 
first dry and harsh, but it will soon become loose; 
the duration of the trouble is rarely as long as one 
week. 

In cases in which this type of cough lasts for 
weeks or months a tubercular infection of the glands 
located at the spot where the wind-pipe divides into 
the large bronchi must be suspected. This is perhaps 
the most frequent type of tuberculosis in childhood, 
and it should always be looked for in any case of 
chronic cough in childhood. 

Adenoids will also cause chronic coughs of this 
type, wdiich will disappear promptly upon their re- 
moval. 

Real bronchitis which involves the smaller bron- 
chial tubes is by no means as frequent as the in- 
flammation of the w r ind-pipe in children, and it seems 
that this is favoured in many, if not the majority of 
cases, by the lymphatic constitution, and it is then 
observed in the fat, pale children who are prone to 
repeated attacks of this illness ; it is also often seen 
in rickety children. 



OTHER DISEASES OF CHILDHOOD 229 

If the disease should involve many of the smaller 
bronchial tubes it \vill seriously interfere with the 
aeration of the blood in the lungs, and the child will 
be short of breath; the tough secretion in the bron- 
chial tubes permits the ingress of air, but the expira- 
tory force is insufficient to permit the egress of air; 
the lungs will remain dilated, the chest expanded, 
and expiration is difficult and accompanied by a 
whistling, wheezing noise. The secretion is at first 
tough, later loose and like matter ; as children under 
seven years do not expectorate we will only see this 
then when the child vomits. 

In older children the disease is not serious under 
the proper care, while it is a frequent cause of death 
in infants, as we have seen before. 

Chronic bronchitis and asthma are in lymphatic 
children the results of the dilatation of the lungs, 
due to repeated attacks of acute bronchitis. Usu- 
ally we hear the story that a child at school-age is 
very susceptible to climatic changes and that it is 
suffering from one attack of bronchitis after an- 
other, so that it has to be kept from school most of 
the winter; frequently the child will also be suffer- 
ing from asthmatic attacks. The physician will find 
on his examination that the chest is distended and 
the lungs are overfilled with air. 

Long-continued treatment with changes of cli- 
mate will cure these cases, but unfortunately only 
the wealthy can avail themselves of these measures. 
It is needless to add that the lymphatic constitu- 



230 THE CHILD IN HEALTH AND ILLNESS 

tion must be taken in hand before we can expect a 
result from any kind of treatment. 

Diseases of the Lungs. Up to the age of three 
years the inflammation of the bronchial tubes is very 
liable to descend into the lungs and to cause here a 
disseminated inflammation, a so-called broncho- 
pneumonia, one of the most dangerous diseases of 
young children. After this age, except in severe 
cases of whooping cough and measles, the children 
suffer from the lobar form of pneumonia, in which 
part of a lobe or a whole lobe or even more than 
one lobe of the lungs is involved. This latter dis- 
ease starts suddenly with a chill and high fever, 
pain in the chest and a dry racking cough. After 
a few days the cough becomes loose and in children 
over seven we will then observe the rusty-brown ex- 
pectoration which is so characteristic of the disease. 
Later the expectoration will look more like pus. 

The fever remains high for a week or more and 
it then comes down suddenly and will frequently 
drop down way below the normal; at this time the 
heart must be watched very carefully. 

Whenever the pneumonic infection reaches the 
outer part of the lung itr outer covering, the pleura, 
will be affected and the inflammation of this is the 
so-called pleurisy. This pleurisy may either be dry, 
when it is rather painful so that the child will be 
afraid to cough, or that part of the chest will become 
filled with liquid, which then encroaches upon the 
space for that lung, and thus results in shortness of 
breath. In children this liquid in the chest will in 



OTHER DISEASES OF CHILDHOOD 231 

many cases disappear by itself, but in quite a con- 
siderable number the physician will have to with- 
draw some of it before the child can recover. In 
some cases also, especially when the child has har- 
boured in its system a purulent infection, as for in- 
stance a running ear, the pleuritic liquid is liable 
to be transformed into pus (empyema) ; these cases 
will require surgical intervention for their relief. 

Tubercular infection of the lungs is of the rapid 
type in young children ; in older children it is in no 
way different from that in adults. 

DISEASES OF THE DIGESTIVE ORGANS 

The Mouth. Inflammations of the lining of the 
mouth are most frequent in infants, as we have 
seen above, but later in life we will also observe 
some of these. 

In feverish diseases, especially in pneumonia and 
in the grippy infections, w r e can frequently observe 
small blisters to appear around the mouth, on the 
lips, which later form sores; this herpes, or as it 
is commonly called " cold-sores,' ' may also appear 
inside the mouth. 

The care of the teeth has been spoken of before. 

On the tongues of lymphatic children we may 
frequently observe a peculiar coat which covers part 
of the tongue, assumes all kinds of phantastic 
shapes, and may suddenly disappear to reappear 
again quite as suddenly ; this so-called ' ' geographic 



232 THE CHILD IN HEALTH AND ILLNESS 

tongue" is one of the characteristic symptoms of 
the lymphatic constitution. 

Appetite. A poor appetite, which is usually com- 
bined with constipation, is one of the most frequent 
troubles in children. On investigation the physician 
will either find that the child has been overfed for 
some time, especially with meat, and then a proper 
change in the diet will be all that is required to rem- 
edy this condition ; or he may find that the dietary of 
the child was too monotonous, often containing too 
much milk, and the remedy for this condition will 
also be obvious ; or finally the child may be suffer- 
ing from an actual loss of appetite with consequent 
undernutrition and a weakening of all the muscles. 
These cases may be very obstinate and they require 
the most careful handling; frequently we will ob- 
serve this condition in the nervous children of nerv- 
ous parents and they may then, by no means rarely, 
suffer also from nervous vomiting, a condition which 
is among the hardest for the physician to combat. 

Constipation. Chronic habitual constipation is 
also very frequently observed; usually the condi- 
tion is an inherited one, but it is at the same time 
the result of a faulty bringing up of the child com- 
bined with a diet which contains an insufficient 
amount of residue. In these cases the diet must be 
carefully regulated first of all, and the child must 
be taught to go to the toilet at the same time every 
day, and that it must not be allowed to leave it until 
it has done its duty. We must, however, remember 
that each child has hy nature its own time for this 



OTHER DISEASES OF CHILDHOOD 233 

function and that it is very difficult to change this 
time, though it may be very inconvenient, coming, 
for instance, during school-hours. But here as 
everywhere the child's health is the first considera- 
tion, and teachers should show a little more regard 
for this than they are wont to do; when necessary 
the parents should request the teacher to allow the 
child to leave the class-room at the appointed time 
regularly every day. 

The best time for an evacuation of the bowels is 
naturally early in the morning on arising, at which 
time it will not interfere with anything else. A glass 
of cold water taken the first thing in the morning, 
on awakening, will often be all that is needed to 
regulate the function of the bowels. 

Medicines for the evacuation of the bowels, even 
suppositories or injections, should not be employed 
for any length of time without the physician's or- 
ders, and the latter will frequently find some means 
of getting along without the habitual use of any of 
these unnatural measures. 

Dyspepsia. Dyspepsia in older children, a 
"spoiled stomach," is perhaps the most frequent 
disturbance of health; it is very apt to occur after 
holidays and after children's parties; it is then due 
to an overloading of the stomach with sweets and 
greasy foods. A dose of castor oil, followed by a few 
days of restricted diet, will cure this condition in 
short order. In some children, however, things are 
not quite as simple as all this ; they react with high 
fever, severe vomiting of undigested food and head- 



234 THE CHILD IN HEALTH AND ILLNESS 

ache; some children will also have convulsions and 
will be in a deep coma ; at the same time when ap- 
proaching the child one will be able to perceive a 
peculiar odour around the child, similar to that of 
rotting apples. This condition demands most care- 
ful treatment by the physician and the diet of these 
children must be regulated very carefully. 

Some children react to any excess in eating or to 
unaccustomed food by having attacks of diarrhea. In 
these cases also we must carefully superintend the 
feeding of the child, and we will then be able to 
overcome this irritability of the intestine. 

Appendicitis. Appendicitis is very frequent in 
childhood. It appears in two types. Either the 
acute, which is always a surgical disease, and which 
may lead to peritonitis wdthin a few hours if not 
operated at once; w T hile it is relatively harmless if 
the surgeon is allowed to remove the offending or- 
gan in time. Or it may be a chronic affection, when 
the child w r ill complain of occasional, more or less 
frequent, pains in the stomach or a stitch in the side 
after exertion or after a hearty meal. Inasmuch as 
we can never tell when this chronic appendicitis may 
light up into the acute form, this condition should 
also be remedied by the removal of the diseased 
appendix before it will have had a chance to cause 
the formation of an abscess or before the repeated 
attacks of inflammation will have left adhesions 
which will make an operation, which is most likely 
demanded sooner or later, a difficult one. 

Tuberculosis. Tubercular disease of the abdom- 



OTHER DISEASES OF CHILDHOOD 235 

inal organs is by no means rare in childhood. Most 
frequently we will find an infection of the glands 
along the spine and in the mesentery, by which the 
bow T els are attached; next in frequency is tubercu- 
lar peritonitis; this may appear in either of two 
types, the exudative in which the abdomen is dis- 
tended by a large amount of liquid, or the dry type 
in which the intestine is matted together in such a 
manner as to interfere with its motility and its 
proper function. In the exudative type operation, 
removal of the liquid, has been found effective in 
many cases ; of late the treatment with exposure to 
sunlight has given some remarkable results in both 
forms, as in tuberculosis in general. 

Ruptures. Herniae, or ruptures, where the intes- 
tine leaves the abdominal cavity through one of the 
preformed openings and where it can be felt under 
the skin, are quite frequent in childhood. 

Umbilical hernia, rupture at the navel, appears in 
infancy and it should not be treated with one of 
the many kinds of trusses which may be bought or 
with home-made ones because the majority of these 
make the condition worse or prevent healing; the 
best remedy consists in strips of adhesive plaster 
properly applied by the physician. 

Inguinal hernia, rupture in the groin, is mostly 
found in boys. Here a well-fitting truss made of a 
skein of wool and properly applied may remedy this 
condition (see Fig. 58). If it persists after the first 
year of life an operation, which is not dangerous, 
will give most universally good results and effect a 



236 THE CHILD IN HEALTH AND ILLNESS 

permanent cure. This is surely preferable to the 
constant wearing of a truss, with its irritation of 
the skin and the pain and discomfort; in the end it 
will prove to be cheaper as well. 

It is necessary to state here that crying will not 
cause a rupture, though it may enlarge an existing 
one; the tendency to ruptures is present at birth 
and it is in many cases inherited. The writer has 
seen three brothers with this condition who were all 
cured by- operation; one of their sisters was also 
cured by the surgeon of a very large abdominal 
hernia. 

Bectum. Of the diseases of the rectum, the last 
part of the bow^el, two are most frequently observed 
in childhood. Fissure of the anus, where the rectum 
joins the skin, is in the first place due to the forced 
passage of large hard stools, which overstretch the 
anus and result in a tear in the skin in this loca- 
tion. This tear is so painful when the stools pass 
over it that the child will fight against this from 
dread and it will then suffer from secondary con- 
stipation. By slight cauterisation the physician will 
be able to remedy this condition in a short time. 

Some children, from two to four years of age as a 
rule, who are suffering from difficult evacuations of 
the bowels will press so hard at stool as to press 
out part of the rectum, so-called prolapse; in this 
condition the stools must be carefully regulated first 
of all, and they must be passed in the prone position 
on the back. The physician must also teach the 



OTHER DISEASES OF CHILDHOOD 237 

mother how she can prevent the bowel from pro- 
truding*. 

Parasites. Itching around the anus is most fre- 
quently duo to animal parasites which live in the 
lower bowel, the so-called thread-worms, which look 
like pieces of white thread cut to the length of about 
two-fifths of an inch and which can be found readily 
on inspection of a spontaneous stool or after the 
injection of w T ater into the lower bowel; their eggs 
are also easily found by the physician by scraping 
over the skin around the anus and examining this 
under the microscope. 

Owing to the itching, the child will scratch itself, 
especially at night, and then the eggs get on its 
fingers, whence they are transferred to the mouth 
and the child will thus reinfect itself; this is the 
reason why it is often so difficult to rid the child of 
these parasites, and in all cases the child should wear 
closed drawers by day as well as by night to prevent 
this reinfection. 

Of the other animal-parasites living in the human 
intestine two are also quite frequently found in 
children. First the round-w r orm, which is from eight 
to twelve inches long and as thick as a large wooden 
knitting-needle ; this may be found in the stools and 
it may also be pulled by the child from its nose 
or mouth ; its eggs may be found in the stools by the 
physician. Second the tape-worm, which appears in 
the stools like pieces of tape cut into varying lengths. 
The eggs of the round-worm get into the child 



238 THE CHILD IN HEALTH AND ILLNESS 

through raw vegetables, those of the tape-worn 
through raw or underdone meat. 

Mothers still frequently refer all kinds of nervous 
symptoms on the part of the child to worms, such 
as picking of the nose, restless sleep, grinding of tin 
teeth during sleep, etc. ; the physician however wil 
want to be sure of his ground and will want to sec 
the offending parasite or find its eggs under the 
microscope before he subjects the child to the treat 
ment against worms ; the more so, as in most cases 
this suspicion is unfounded. When the diagnosis of 
worms has been confirmed strict adherence to the 
physician's directions, not only as to medication bu1 
also as to washing after stools, frequent changes of 
the underclothing and the bedclothes, etc., have to be 
carried out religiously to insure the success of the 
treatment, which is sometimes by no means easily 
accomplished. 

Diseases of the Liver. Enlargement of the liver 
is frequent in young children in whom it is very 
often found when they are rachitic. Tuberculosis 
and congenital syphilis will also frequently cause an 
enlargement of this organ. 

The one disease of the liver which is most fre- 
quently observed in older children is catarrhal 
jaundice. This disease seems to be epidemic at cer- 
tain times, so that several children in one family 
will be suffering from it at once or in short suc- 
cession. It is more frequent in girls than in boys. 
The child will be suffering for two days from gen- 
eral symptoms, such as headache, nausea, vomiting, 



OTHER DISEASES OF CHILDHOOD 2 3 c> 

onstipation, slight fever, and a coated tongue, 
hen, usually on the third day, the whites of the 
yes and the skin will show the characteristic yel- 
3W colour, the urine will now get dark and the stools 
ght, greyish-white. The liver is enlarged and may 
e tender. The child may also suffer considerably 
rom itching. The disease lasts only rarely longer 
lan three weeks. Then the stools will be coloured 
gain, the urine will become lighter, and, last, the 
kin will again assume its normal colour. Though 
le child will as a rule be quite lively, it is better 
o keep it in bed because this innocent infection may, 
lough it rarely does, assume a dangerous nature. 

DISEASES OF THE URINARY ORGANS 

The Kidneys. Inflammations of the kidneys are 
>y no means as rare in childhood as had been gen- 
erally assumed; inasmuch as any severe affection 
)f these important organs is liable to become 
chronic and to lead to prolonged invalidism and 
eventual death, an examination of the urine should 
be a routine measure in every illness of childhood. 

Inflammation of the kidneys, nephritis, is usually 
the consequence of one of the infectious diseases, 
and among these scarlet fever takes the most 
prominent part, so much so that in cases in which 
this disease has been overlooked an examination of 
the urine may reveal the diseased condition of the 
ddneys, and then careful inspection may show that 
some scaling of the skin is still persisting; but 



2 4 o THE CHILD IN HEALTH AND ILLNESS 

even a slight grippy infection may damage th< 
kidneys irreparably. 

Whenever the child should complain of headache, 
vomiting, and loss of appetite the urine should b< 
examined ; when the kidneys are diseased it will f re-l 
quently be reddish-brown from the admixture of 
blood. When the secretion of the urine is diminished 
the first signs of dropsy will be noticed as a baggi- 
ness under the eyes and a swelling of the ankles. 
In severe cases the dropsy may assume large pro- 
portions and the lungs may be flooded with the 
retained liquid. Chronic nephritis causes serious 
injuries to the heart. 

Tuberculosis of the kidney is not rare in children, 
though it is usually observed in children who have 
the symptoms of tuberculosis in other organs. 

Stones in the kidneys or bladder are mostly ob- 
served in Hungarian and Asiatic children, though 
they may also be found in others. 

Inflammation of the bladder, cystitis, which may 
ascend into the kidneys in severe cases, is relatively 
a frequent disease especially of early childhood; it 
is mostly observed in girls and is then due to the 
infection with the germs of the stools in diarrhea. 
In girls the urethra is very short and its opening 
wide, so that the bacteria may easily enter, especially 
when the child, having soiled itself with its stool, 
is cleaned by wiping toward the urethra. Great care 
must, therefore, be taken to always clean the child 
from the anus backward. 

The symptoms of cystitis are irregular fever and 



. OTHER DISEASES OF CHILDHOOD 241 

painful as well as frequent urination. Examination 
of the urine will make the diagnosis sure. When 
the disease has not been recognised in time it may 
last many months, but even under the best of timely 
care it may be quite obstreperous. 

Phimosis. In boys a tight adherent foreskin with 
a narrow opening will lead many times to difficulties 
in urination and also to inflammations of the parts, 
especially in summer. Stripping the foreskin back 
in the bath and cleanliness of the parts will many 
times remedy this condition, but if the mother should 
be unable to do this the physician w r ill readily suc- 
ceed in most cases; only rarely will surgical inter- 
vention be required, though circumcision is a slight 
operation, the effect of which is lasting. 

Infection. Infection of the outer genitals is, es- 
pecially in girls, a frequent and very persistent 
trouble, which requires careful and long-continued 
local treatment. 

Masturbation. A word also about masturbation 
or self -abuse which may be observed even in very 
young children ; this may be due to irritation of the 
genitals by thread-worms, or from a tight foreskin 
in boys or an inflammation in girls. It requires the 
most careful attention and observation to make the 
diagnosis, and the treatment of this bad habit is very 
difficult even under the most favourable conditions. 

DISEASES OF THE NEEVOUS SYSTEM 

Meningitis. The inflammation of the membranes 
covering the brain and the spinal cord is due to an 



242 THE CHILD IN HEALTH AND ILLNESS 

infection ; it is usually the consequence of an infecJ 
tion in or near the head, such as in the ear or th( 
nose. It may also spread to the meninges from th< 
other infections such as pneumonia, erysipelas or in- 
fected eczema. Or the bacteria may be introducec 
directly through head injuries. 

The symptoms are first general, high fever, severe 
headaches, and vomiting without retching, the 
vomited matter being shot out in a large gust. The 
typical symptoms from the brain consist in delirium, 
stiffness of the neck, convulsions and then uncon- 
sciousness, which may be interrupted by sudden 
cries. 

We now have a comparatively easy means of diag- 
nosing these cases, by the so-called spinal-puncture, 
which consists in pushing a hollow needle into the 
lower spinal canal and thus obtaining some of the 
spinal fluid for examination. As this spinal-puncture 
has also been found to be really a curative measure, 
parents should give their permission for the per- 
formance of this procedure, which is almost painless. 

Meningitis is in most cases a fatal disease, and 
even those cases which recover may have their brains 
left in such a damaged condition as to leave the little 
patient deaf, or blind, or an idiot. 

Tubercular meningitis is a disease of young 
children mostly. It usually ends fatally in from two 
to three weeks, though quite recently some cases of 
this disease have been reported cured by spinal- 
puncture. Its course is similar to that of the other 
forms of meningitis. Frequently the little patient 



OTHER DISEASES OF CHILDHOOD 243 

may wake up from its unconscious condition and act 
quite naturally, even sit up in bed and play for a 
few hours, and then be dead in from twenty-four to 
forty-eight hours. This is liable to instil a ray of 
hope in the parents which is sure to lead to a dis- 
appointment which is so much severer. 

Tumors. Tumors of the brain are also sometimes 
observed in children. In rare cases an operation 
may offer some chance for recovery. 

It would lead too far and it would not be within 
the province of this book to mention the many dif- 
ferent kinds of spasms and paralyses due to diseases 
of the brain and spinal cord. We will now mention 
briefly some of the so-called functional disturbances 
which may be observed in children. 

Epilepsy. Epilepsy is a disease which frequently 
begins in childhood ; it consists in convulsions which 
are accompanied by unconsciousness. In cases of in- 
fants suffering from convulsions the physician will 
be placed before the question, if these convulsions 
are the first signs of epilepsy or if they are due to 
other causes. Whenever a child which has been well 
so far begins to have "fainting spells " in his third 
or fourth year this should be suspicious of epilepsy. 

Epilepsy is especially frequent in children who 
have sprung from nervous families, in which one or 
more of the ancestors on either or both sides have 
suffered from insanity or epilepsy. In the offspring 
of consanguineous marriages of persons of such 
tainted heritage the disease is still more likely to 
appear. 



244 THE CHILD IN HEALTH AND ILLNESS 

Epileptics are best taken care of in one of the 

colonies for such patients and they should never be 
allowed to marry. 

Hysteria. Hysteria is by no means a rare trouble 
in children, even infants, and the protean picture 
which it may present in the adult will be made even 
more complicated owing to the youth of the patient. 
The treatment of hysteria in children is much easier 
and more successful than in adults, though it will 
often be difficult to carry it out in the surroundings 
of the home, while the recovery will be much more 
rapid and prompt when the case can be treated in a 
hospital or an institution. 

Spasms. Tics or spasms of some of the muscles 
of the face may at first only be bad habits and often 
only in imitation of some person, especially the 
teacher, but once they have taken hold of the child 
they are very difficult to eradicate and they then 
require long-continued treatment. 

Night-terrors. Night-terrors are attacks of fright 
in children, usually before midnight, a few hours 
after the child has gone to sleep. The child will sit 
up in bed and cry w T ith terror and complain of some 
fancied apparition ; it is usually not entirely awake, 
and it will go to sleep again after it has been quieted 
down ; in the morning it will not have any recollec- 
tion of the nightly occurrence, which may be re- 
peated night after night. These attacks are most 
frequently seen in children who have adenoids, and 
with their removal the attacks usually disappear. 
The telling of ghost-stories and fairy-tales in the 



OTHER DISEASES OF CHILDHOOD 245 

evening and hard playing before the bed-time are 
also a frequent cause. 

Bed-wetting. Bed-wetting, the involuntary act of 
urination during sleep, which may in severe cases 
be also an occurrence during the day when the child 
forgets itself during intense playing, is a nervous 
affection, and it has usually nothing to do with dis- 
eases of the urinary organs. It must be regarded as 
a disease; punishment is not only useless but the 
fear of it may make the condition worse. 

The trouble is usually a continuation of the in- 
voluntary urination of infancy, though it may also 
set in after the child has been keeping itself dry 
for some years. It requires careful management; 
it is very important not to let the child have any- 
thing to drink after five in the afternoon and to 
take it up once or twice before midnight, before the 
time when the accident is most likely to occur. As 
it has been found that these children usually wet 
their bed when they are sleeping on their backs some 
means to prevent this, such as tying a brush to the 
back, will also help in many cases. Even after the 
child has been apparently cured the accident may 
happen again occasionally for some years. 

DISEASES OF THE SKELETON" 

Fractures. In the newborn, after difficult labour, 
fractures of the upper arm or of the thigh-bone are 
occasionally observed. In young children fractures 
are rarely complete, as they will be later in life 



246 THE CHILD IN HEALTH AND ILLNESS 

when the bones will have become harder, but they 
will be seen in the form of a severing of the con- 
tinuity of the bone on one side only, the same as we 
observe when we bend a green stick too far; they 
are therefore called green-stick fractures. In rickets 
and in scurvy fractures or separation of the ends of 
the bones are not infrequently observed, but they 
may be easily overlooked by the mother. 

Another fracture which is very easily overlooked, 
even by careful mothers, is that of the collar-bone, 
which is the most frequent in children. In older 
children fractures do not differ in any way from 
those in adults, and with the Eoentgen rays, which 
now are accessible even in smaller communities, the 
position of the broken ends can be controlled and 
malunion and deformities can now much easier be 
avoided. No fracture should be treated without this 
valuable aid. The X-rays have also shown that 
many cases of so-called sprain of the wrist or ankle 
are in reality fractures and must be treated as such, 
and that the injuries to the fingers from baseballs 
are likewise fractures, usually of the last bone of 
the finger; the unsightly deformities of the fingers 
can be easily avoided by appropriate treatment. 

Dislocations. Dislocations of joints when caused 
by injury are most frequent in the shoulder and they 
require careful treatment, as they might otherwise 
become habitual. Congenital dislocation of the hip- 
joint, either on one side only or on both sides, is 
most frequent in girls. This is usually not recog- 
nised until the child can walk, and then it is evident 



OTHER DISEASES OF CHILDHOOD 247 

by the characteristic waddling gait. This can now 
be cured in many cases by manipulations and 
plaster-casts without the use of the knife. The best 
time for the reduction of this form of dislocation 
is between the third and the sixth year of life ; after 
the seventh year this method is rarely successful 
and operation will have to be resorted to. 

Diseases of the Bones. An infection of the bone 
with the pus-producing germs is not rare in children ; 
it is characterised by high fever, severe pain, and 
swelling in one of the long bones. This condition de- 
mands immediate operation, otherwise, if this has 
been delayed too long, even an amputation may 
not be able to save the child's life. 

Tuberculosis. Tuberculosis of the bones or joints 
is a very frequent disease of childhood and it should 
be thought of when the child can not use one of 
its limbs well, or when it limps or drags its leg, 
or complains of backache when sitting up. When the 
disease affects one limb this will usually remain 
more or less useless, provided the disease has 
not been recognised and treated early. If it should 
be in one or more vertebrae the child may remain 
a hunchback. The physician has, however, the means 
of obtaining most remarkable results in these cases 
with exposure to sunlight, provided he sees them 
early enough, before the destruction has gone too 
far; though, at best, the treatment has to be con- 
tinued for many months, and this is very trying to 
the little patients as well as to their parents. "We 
should, however, never forget how much it will mean 



248 THE CHILD IN HEALTH AND ILLNESS 

for all concerned if the child can be cured, no mat- 
ter at what cost in money and patience, yea, even 
suffering, rather than that it should remain a cripple 
for life. 

Malformations. Congenital malformations of the 
bones are rather frequent occurrences. Club-foot 
is the most frequent. This should be taken in hand 
as early as possible, best at the end of the first 
month of life, and then manipulations and plaster- 
casts will cure many of these cases completely, no 
matter how severe. Harelip and cleft palate, which 
are due to the failure of the skin and bones of the 
upper lip and palate to unite, can also be cured by 
an early operation, about the sixth month of life, 
and the results will then often be remarkably good. 
Other malformations are much rarer. 

Curvature of the Spine. Curvatures of the spine 
are in many cases the result of rickets. They can 
then be observed in young children and should be 
treated at once. In young girls they are often due 
to faulty posture in school, at a time when the child 
is growing rapidly. Gymnastics and properly ap- 
plied apparatus, which, however, should be made un- 
der the supervision of the orthopedic surgeon, wall 
overcome this deformity. In boys it is also observed, 
though less frequently. 

FOREIGN BODIES AND POISONS 

Foreign Bodies. Some young children have a 
habit of putting things in their ears, nose, or even 



OTHER DISEASES OF CHILDHOOD 249 

their genitals, where these things may remain un- 
noticed for a long time, though they will usually 
cause some trouble sooner or later. 

Whenever a child has a persistent discharge from 
one nostril this should make us suspicious of a for- 
eign body in that side of the nose, and the writer 
has removed a number of beans, shoe-buttons, wads 
of paper, etc., which, undoubtedly had been intro- 
duced a number of weeks before. Laymen should 
never try to remove such a foreign body, for they 
will, as a rule, only make it so much harder for the 
physician. 

Foreign bodies in the eye, especially cinders, 
which may burrow deeply into the lucid part of the 
eye, should also be attended to by the physician; 
home-remedies such as the placing of a flax-seed 
into the pouch of the eyelid for this purpose, will not 
do any good. 

Some children have a habit of placing dirt of all 
kinds into their mouths, and it is a very difficult 
undertaking to break them from this filthy habit, 
once it has become inveterate. 

Needless to say that a child which observes its 
mother or nurse placing safety-pins or needles into 
her mouth will likewise do so, and many a mother 
will save herself some anxious hours if she will only 
remember to refrain from setting the child so bad 
an example. 

Jackstones, beans, small coins, the little whistles 
from rubber dolls, and so on, may be aspirated into 
the windpipe and the larger bronchial tubes, and 



250 THE CHILD IN HEALTH AND ILLNESS 

even the specialist may find it extremely difficult to 
remove them. 

Poisons. First one word about the different 
kinds of cleansers, both in dry and in liquid form, 
which are used so much in households. They con- 
tain, one and all of them, strong lye, and if left 
around carelessly where the child can get at them it 
may swallow some of them and then suffer severe 
damage to its throat and gullet which will frequently 
be fatal even after some years. Much better not to 
have these things around the house at all ; the manu- 
facturer of these cleansers should be forced by law 
to label them for what they are as strong caustic 
poisons. 

Medicines, especially those in tablet form, which 
frequently contain some very powerful drugs, also 
antiseptic tablets, should never be left lying around 
in the home ; only too often will a child pick them up 
and eat them for candy. 

Pure carbolic acid also should never be left around 
and is best not to be found in the household. Even 
with very dilute carbolic acid one must be very care- 
ful in children, as a dressing with a dilution of this 
acid may cause gangrene. The best and quickest 
antidote for carbolic acid, and one which should al- 
ways be found by its side in the medicine closet, is 
alcohol, which neutralises the acid at once. 

For poisoning with acids a mild alkali, such as 
baking soda, for poisoning with alkalies and caus- 
tics a mild acid, such as lemon juice or diluted vine- 
gar, should be administered at once. 



OTHER DISEASES OF CHILDHOOD 251 

In poisoning with powerful drugs, such as opi- 
ates, strychnia or atropine, the child should be given 
at once, before the arrival of the physician, white 
of egg to bind the poison and should be made to 
vomit with warm salt and water or mustard water, 
as the delay of a few minutes may be decisive. 

But here as well as in other matters in medicine 
prevention is better than a cure. All powerful drugs 
and medicines should be locked away in a medicine 
closet beyond the reach of the child ; then only will 
the mother have a reasonable assurance that the 
child can not get at them. 



CHAPTER XVI 

DEFECTS OF THE EYE AND BLINDNESS IN 

CHILDREN 

BY F. PARK LEWIS, M. D., F. A. C. S. 

THE proper time to consider the eyes of the 
newborn child is before he is born. A recog- 
nition of possible contingencies that may occur is 
part of the modern programme of preparedness. To 
be obliged to say to the mother of a newborn infant 
that there exist serious defects of its eyes is only 
less dreadful than to say that the child is a mon- 
strosity. If by the exercise of any measures sight 
may be preserved, that would otherwise be lost, no 
efforts can be considered too great. 

The defects of sight that the child may bring into 
the world are of two kinds ; those due to pre-exist- 
ing disease in the mother, and those due to defects 
in development of the eyes of the child. 

In a most admirable series of studies the late Dr. 
Charles Stedman Bull demonstrated the urgent ne- 
cessity of recognising the presence of constitutional 
disease in the mother before the birth of the child, 
in order that active measures for its control might 
be promptly instituted, and the disasters might be 
avoided. 

252 



BLINDNESS IN CHILDREN 253 

It is no less necessary when this has been over- 
looked to recognise early the presence of such dis- 
ease in the infant, and to put the baby under cor- 
rect and effective treatment as soon as may be. The 
presence in the genital tract of the mother of viru- 
lent infectious germs should, when possible, be rec- 
ognised and controlled before the child is born. 

By instituting active measures the otherwise al- 
most inevitable infection of the eyes may be avoided 
and a serious menace to the sight of the infant ob- 
viated. 

Children may be born with defects of almost any 
of the essential eye structures. These may include 
imperfections of either of the eyelids, defects, im- 
perfections or complete absence of structures of the 
eyeball, extending back to the optic nerve, or the 
eyes may be too small or entirely absent. 

When the sight is exceedingly imperfect, either 
because of defects inside the eye or because of scars, 
twitching of the eyes, so-called nystagmus, is com- 
monly found present. 

The desirability of an early recognition of existing 
defects can not be too strongly emphasised, because 
even when no remedial measures can be instituted 
the parents will not readily overlook what may be 
regarded as negligence in the examination of the 
child on the part of the physician. 

Examination of the Eyes of the Newborn. Not 
only for the satisfaction of the parents, but equally 
for his own protection, it is important that the eyes 
of the child be carefully examined by the accoucheur 



254 THE CHILD IN HEALTH AND ILLNESS 

immediately after the baby is born. Unless a very 
valid reason exists, as in the case of the premature 
child, a preventive against infectious inflammation 
of the eyes will immediately be used. With the pre- 
mature child, where the vitality is low, this is fre- 
quently not well borne. It is well at such a time, 
even after the fatigue of a long vigilance at the bed- 
side of the mother, to have the child brought to 
the light in order that the physician may assure him- 
self that the eyes are normal. Should the eyes of 
the child become inflamed or reddened, or should a 
discharge come from them, the case should, for the 
protection of the doctor, as well as for that of the 
child, in accordance with the legal requirements now 
existing in almost every state, be promptly reported 
to the department of public health. In those cases 
in which the family are unable to meet the added ex- 
pense, the service of a specially qualified nurse will 
be provided by the health department. Measures 
are also provided by the department for the exami- 
nation of smear slides, so that the nature of the in- 
fection may be recognised. 

It must never be forgotten that any pus infection 
of the eyes of a newborn child is a matter of grave 
importance, requiring skilled treatment, good nurs- 
ing and constant attention. Except in the simpler 
cases the care of a capable eye specialist should be 
secured, and the eyes of the child can not be consid- 
ered safe until the discharge has finally ceased. 

Strabismus. When the eyes cross in a young 
child it is an almost invariable indication of the ex- 



BLINDNESS IN CHILDREN 255 

istence of marked refractive errors, in the absence 
of disease of the brain. Hyperopia, far-sightedness, 
which is a congenital shortening of the eyeball, or 
astigmatism, in which the anterior part of the eye is 
elliptical instead of round, and which therefore ne- 
cessitates great effort on the part of the muscle in- 
side the eye to blend the images, are usually present 
and often co-existent. 

The first essential is, therefore, that the refrac- 
tion be properly corrected as soon as the child is old 
enough to wear the necessary glasses. The writer 
has successfully prescribed glasses in such cases for 
children under a year old, thereby relieving the 
strain upon the eyes and permitting a normal muscle 
balance, and therefore avoiding the necessity of a 
subsequent operation. 

Of even greater importance than this, however, is 
the development of the nerve centres in the brain 
brought about by binocular vision. When this is 
not done the in-turned eye becomes dull-sighted, and 
a restoration of vision at a later date is exceedingly 
difficult. 

Eye Strain. Eye strain is a result of refractive 
imperfections, chiefly far-sightedness and astigma- 
tism, and may manifest itself in several ways. The 
eyes become blurred and tired after use, headache 
may be in the forehead, in the temples, or in the 
back of the head. It may cause inflammation of the 
eyelids, or irritation of the lid margins, while re- 
mote effects are by no means uncommon, such as 



256 THE CHILD IN HEALTH AND ILLNESS 

excessive nervousness, digestive disturbances, etc. 

The character of the headache will often serve in 
helping to determine its origin. Headaches which 
occur in the front of the head, and more frequently 
in the morning after rising, with heaviness and a 
flushing of the eyes, are more commonly due to nasal 
obstructions or adenoids, while eye-headaches occur 
during the day and are increased by the use of the 
eyes. 

Glioma. One of the conditions most to be dreaded 
and demanding early recognition in young children 
is glioma, or malignant growth of the eye. It prob- 
ably is present in an undeveloped form from birth, 
but it is usually between the fourth and fifth years 
of childhood that it becomes sufficiently developed to 
be visible to the naked eye. Happily, it is an ex- 
ceedingly rare occurrence, being present in about 
one of ten thousand cases of eye diseases, and, more 
fortunately, it rarely involves both eyes. The pupil 
is usually enlarged and when the malignant growth 
has sufficiently invaded the eyeball it can be seen 
through the pupil as a yellowish opacity. While it 
is still encapsulated within the eyeball the life of 
the child may be saved by the prompt removal of 
the eye, but having once invaded the tissues around 
the eye, extension of the cancerous growth is rapid 
and inevitable. 

Phlyctenular Ophthalmia. As the baby passes 
from infancy to early childhood another serious con- 
dition is apt to occur, w T hich often does not receive 



BLINDNESS IN CHILDREN 257 

the prompt attention it demands. Whether it is al- 
ways tubercular in character or not is still a moot 
question. It is certainly a condition in which the 
digestion must receive first attention. It begins with 
a dread of the child to bear ordinary daylight. The 
eyes are watery and weak and it may be accom- 
panied by an eczema of the lids. Sometimes a like 
condition involves the nose, though not infrequently 
the eyes alone are affected. If the eyes are carefully 
examined, which is difficult because of the dread of 
the child to bear light, a small blister will be found 
at the margin of the lucid part of the eye, the cor- 
nea, frequently extending into the cornea. The im- 
portance of an early recognition and prompt treat- 
ment of such cases is emphasised by the fact that 
scars will follow T the healing of these ulcerated sur- 
faces, and when ultimately the eyes recover, as they 
usually do, the sight will be found permanently de- 
fective. Every line of clear cornea, therefore, that 
can be conserved is of the greatest value, for neglect 
means permanent loss. 

Among the poorer classes of people, and in dis- 
pensary practice, young children suffering from 
these corneal ulcerations are usually found to be 
badly fed, being allowed all of the indigestible things 
found upon their parents' table. They frequently 
spend the pennies that are given them to solace 
their discomfort for cheap candies. It is of the 
first importance, therefore, that a proper dietary 
should be chosen and insisted upon. 



258 THE CHILD IN HEALTH AND ILLNESS 

DEFECTIVE SIGHT 

The Blind Child. The diagnosis of blindness in 
the child, when such a deplorable condition exists, 
should be made on the earliest possible occasion, and 
it is upon the physician that this responsibility rests. 

The parents will be very reluctant to admit to 
themselves the existence of defects which they so 
much dread, but it is far better for many reasons to 
face facts as they are than to deceive one's patients 
and one's self with vain hopes when blindness is 
once present. 

If it is evident that the child is blind, the whole 
course of its subsequent life will be modified by this 
distressing fact, and the remodelling of plans for 

the child's education will be necessarv. 

%i 

The doctor who has given so much thought to the 
cure of disease, unless he has also been a student 
of social conditions, was not, at least until recently, 
concerned with child welfare. Within the last few 
years the study of the child has taken on a new in- 
terest and an added importance, but even within 
this field comparatively little has been said or writ- 
ten in relation to the management of the child whose 
possibilities are limited by some physical defect. 

There is no one who could more properly advise 
with the parents of a blind child, or of one whose 
sight is so defective as to materially limit its possi- 
bilities of normal development through this afflic- 
tion, than the family physician. It is most impor- 
tant, therefore, that he should not only be able to rec- 



BLINDNESS IN CHILDREN 259 

ognise as soon as possible after its birth that the 
child is blind when this fact exists, but that he should 
be able to suggest to the parents what course shall be 
pursued in regard to the care, the education, and the 
training of the child during those intervening years 
before he can be sent to one of the special schools 
which have been provided for him. 

There are two things, therefore, which it might 
be well to emphasise. First : the necessity of recog- 
nising the fact that the child is blind or has defec- 
tive eyesight at the earliest age possible. Second: 
the manner in which the brain is developed through 
the training of the remaining special senses in the 
absence of sight, in order that by this development 
the child might be able as soon as possible to supple- 
ment the absence of sight by the use of the other 
senses. 

In those cases in which gross physical changes are 
present and in which marked deformity of the eye- 
ball results, it is, of course, easy to determine that 
the child is blind. This is equally true whenever the 
eye-structures are obviously abnormal, such as in 
that rather rare condition of absence of the eye- 
balls, or in abnormal enlargement of the eyeballs, 
in complete congenital cataract, and in other like 
noticeable defects. But there are many cases in 
which markedly imperfect sight or total blindness 
may be present with an apparently perfectly nor- 
mal eyeball. These are the congenital atrophies of 
the optic nerve, or other changes deep in the eye 



26o THE CHILD IN HEALTH AND ILLNESS 

which are discoverable only by the use of the oph- 
thalmoscope. 

To Determine Whether the Child is Blind. As all 
young babies roll their eyes aimlessly during the 
first weeks of life it is difficult to determine, from 
observation merely, the absence of sight. This diffi- 
culty is increased, if, as more commonly happens, 
blindness is not complete, but objects are imperfectly 
seen. If, however, the pupils are widely dilated and 
unresponsive to light, and the eyes continue to move 
aimlessly from side to side without attempt to fix 
them upon an object, and more particularly in the 
presence of spasmodic twitching of the eyeballs, so- 
called nystagmus, associated with an unwillingness 
or an inability on the part of the child to follow a 
light with his eyes when it is moved before him ; all 
of these would be strong presumptive evidence after 
the sixth month that the vision is so imperfect as to 
warrant an ophthalmoscopic examination, by which 
a conclusion can be reached with much greater cer- 
tainty. 

The Blind Baby. However rapid may be the de- 
velopment of the child after it has reached school 
age, the period of greatest plasticity and quickest 
responsiveness is during the months of babyhood 
and the early years following, and it is through the 
sense of sight that impressions, carried to the brain, 
exercise the most profound influence upon the brain 
development. With the visual images every other 
sense-impression is correlated. The object which the 
child sees, in order that he may realise its position 



BLINDNESS IN CHILDREN 261 

in space, must be verified by the sense of touch. All 
of the sensory centres, therefore, which have been 
energised by the touch of the fingers, if the object is 
held in the hand, of the feet as they touch the floor, 
of the arms and the limbs as they move through the 
air, every one of these millions of nerve-units is 
brought into direct relationship with the correspond- 
ing number of other nerve-units, so-called neurons, 
in the sight-centre, so that every motion is sending 
a flood of nervous energy surging through the brain 
of the child. In that way he becomes conscious of 
his position in space, and he develops what is known 
as the stereognostic sense, or the consciousness of 
solid objects. 

Cut off as the blind child is from the primary en- 
ergising influence of the visual impressions he is in- 
tellectually hampered and limited, unless every pos- 
sible supplemental effort is employed to replace, as 
far as may be, the advantages which, in compari- 
son with the seeing child, he is obliged to sacrifice. 

The blind baby, not seeing the objects around him, 
is not, as is the seeing child, unconsciously or per- 
sistently being educated as to their form, their shape, 
their size, their importance, their meaning, in a 
word, their values. He lives in the dark, and every 
motion or every step which he attempts to make is 
an experiment and an adventure. The next step 
may precipitate him he knows not where. It may 
be from the top of the stairw r ay. He can have no 
means of knowing. He is living in a world sepa- 
rate and distinct from that of his seeing associates. 



262 THE CHILD IN HEALTH AND ILLNESS 

This fact should bo early recognised and constantly 
borne in mind. 

The blind baby must be talked to more than the 
child who sees. He must be allowed, carefully, to 
touch the objects about him, in order that in that 
way he may learn what he can about them. He 
must not be allowed to be frightened by taking a 
misstep. He must not be startled by being touched 
suddenly and without warning. A nervous impres- 
sion of that kind may leave its result for months, 
if not for years, upon the sensitive organism. 

"When he is old enough to creep he should be al- 
lowed the freedom of a room, from which all ob- 
jects against which he might hurt himself have been 
removed. The floor should be of one level so that 
there may be no pitfalls for him. He must be al- 
lowed all manner of harmless things to handle, and 
he must always be spoken to as one comes near him 
that he may not be startled. Large motor and sen- 
sory areas of his brain may be trained by allowing 
him to feel, to touch, and to handle things varying 
in degrees of hardness, of smoothness, and of dif- 
ferent shapes and forms. He will in that way be 
getting such approximate impressions as he can, — 
limited as those are compared to the possibilities of 
the seeing child. 

At a very early age, too, auditory areas may be 
actuated by singing simple melodies to the child, not 
in the vague and meaningless way, but carefully 
and in tune where it is possible for the mother to 
do so. The attention in that way can be directed 



BLINDNESS IN CHILDREN 263 

and a recognition of different tones will begin at a 
much earlier age than is ordinarily supposed. Let 
it constantly be remembered that all of the moving 
pictures that pass before our eyes are blotted out 
for the blind baby. There is nothing but darkness 
before his unseeing eyes, and this monotony must 
be varied by greater attention to details that will 
interest him than would be necessary with a seeing 
child. 

At a very early age any other existing corrigible 
physical defects should, if possible, be removed. It 
is bad enough for the child to be blind. He should 
not be still further handicapped by the presence of 
large tonsils, by adenoids, and the consequent in- 
flammation in the ear and deafness, or by any other 
defects of the body. 

If the eyes are so deformed as to be not only use- 
less but offensive in appearance, he should have such 
surgical attention as will make them appear as nat- 
ural as possible. It is much easier for him if this 
is done while he is young. It saves him the em- 
barrassment and handicap in being needlessly dis- 
figured through the years in which he is most sensi- 
tive to criticism. 

Blindism. It is during the early period of a 
child's life that blindism develops. It may be due 
to his struggle to see, or it may be due to irritation 
still existing that he acquires the habit of screwing 
the shut fists in the orbits, making useless motions 
with the face and head and limbs, rolling the head 
from side to side, snuffing the nose, twitching up one 



264 THE CHILD IN HEALTH AND ILLNESS 

side of the face; these and numberless other dis- 
agreeable habits may at this time of the child's life 
be acquired, which later are exceedingly difficult to 
correct. 

Any habits that cause him to be less agreeable will 
make life harder for him. 

The Training of the Blind Child. The training of 
the voice to make it as musical and sympathetic as 
possible will be a great advantage to the child, and 
a quiet, self-possessed manner, instead of a nerv- 
ous and jerky one, will not only make him more 
agreeable but will give him balance of mind as he 
has poise of manner. In a word, before the child 
can be placed under the systematic and special train- 
ing provided for the sightless much can be done by 
the intelligent mother, under the advice of the phy- 
sician, to so aid the child's development as to make 
life easier and simpler when the systematic training 
of the school is wmmenced. 

Delayed Instruction. It is not at all unusual to 
find that children thirteen and fourteen years old 
are reluctantly taken to the schools for the blind 
and find themselves handicapped by their utter in- 
ability to do the simple things that other blind chil- 
dren easily do because of the mistaken kindness of 
parents and friends. They are unable to put on 
their own clothes, to button their shoes, or to use 
their hands and fingers in the simplest mechanical 
efforts. The handicap which they suffer is so great 
that it can never be completely overcome. 

While the child is still very young is the oppor- 



BLINDNESS IN CHILDREN 265 

tune time, therefore, for the physician to make these 
facts clear to the devoted, but uninformed parents, 

and to help them to realise that the greatest kind- 
ness which they can show to their afflicted child is 
to give him the training which alone will enable 
him to compete in the activities of life with those 
who see. 

Schools for the Blind. The time in which the 
blind child should be placed under the instruction 
of those specially qualified to train him in a school 
for the blind is the earliest period at which children 
are admitted, and that is the kindergarten age. 
Very often mothers do great injustice to their chil- 
dren by failing to realise this important fact. A 
mother of a bright five-year-old child who was ad- 
vised to send her to a school for the blind, said: 
"Oh, but I couldn't — you know I am her mother"— 
not knowing that she was withholding from that 
child the only possible advantage that could in any 
way take the place of its lost sight. 

In the kindergarten, as well as in all grades of 
schools for the blind, the same ends are sought as 
in the schools for the seeing. In the literary work 
the curriculum is that of the grammar and the high 
school. In the department of music the teaching is 
that of a thorough and complete school for music, 
including harmony and composition. 

Many of the blind, by reason of the concentra- 
tion necessary, acquire the rare quality of absolute 
pitch, which is unusual among the best trained of 
those who see. Those who are gifted with musical 



266 THE CHILD IN HEALTH AND ILLNESS 

ears, and are willing to do the necessary hard work,! 
become exceedingly proficient npon the piano and 
organ. The hands of the pupils are strengthened 
and the muscles co-ordinated by manual training; 
while those having less intellectuality, but greater 
manual skill, are taught such industries as may be 
performed without sight. These are more varied 
than one would believe. 

The mother of a deaf child will get the most com- 
prehensive advice how she can help her afflicted 
child from a booklet, "What the mother of a deaf 
child ought to know," written by John Dutton 
Wright and published by the Frederick A. Stokes 
Company of New York. 



CHAPTER XVII 
HOUSEHOLD REMEDIES AND MEASURES 

CHILDREN should not be given any medicine 
without the physician's orders, and then only 
for so long a time as he directs. 

The smaller the family's medicine closet the bet- 
ter it will be for the children and the healthier will 
they be, as a rule. 

Patented and proprietary medicines are either 
made and sold with the view that they can not do 
any harm, and they are then and therefore superflu- 
ous, to say the least; or they may contain potent 
drugs which will then be able to do irreparable dam- 
age to the child's organism. 

Infants are frequently given decoctions of pep- 
permint, fennel, caraway or anis-seeds for colic. 
These simple remedies are in themselves not in the 
least harmful, but if we remember that this colic, 
for which they are given, is the first sign of a dis- 
turbance of digestion, which, if neglected, may as- 
sume a most serious aspect, would it not be prefer- 
able to have the physician make the necessary 
change in the child's diet at once and thus to re- 
move the cause for the infant's suffering? 

267 



268 THE CHILD IN HEALTH AND ILLNESS 

Soothing syrups and colic-cures derive their ac- 
tion from very potent drags, such as the opiates — 
paregoric is nothing else but an aromatic tincture of 
opium — and the writer lias seen quite a large num- 
ber of cases of serious poisoning from their adminis- 
tration, in some of which he was not able to save 
the life of the little patient. Fortunately the sale 
of these powerful drugs is now T controlled by law, 
and they can no longer be obtained for a few cents 
for the hiere asking. 

Castoria, the action of which is principally due to 
senna and Rochelle salts, is not the indifferent and 
safe medicine for children which the manufacturers 
try to make us believe, and its indiscriminate ad- 
ministration can not be without bad effect upon 
the child's health. The writer has not seen "chil- 
dren cry for it," but oftentimes after it. 

The only safe ph}^sic for an infant or child is cas- 
tor oil, and this should not be given oftener than 
once in two weeks, at the most, but it should then 
be given in sufficiently large doses so that it will 
really be expelled, as it may be absorbed in small 
doses and then irritate the intestine. The dose for a 
young infant is one to two teaspoons ; later not less 
than one good-sized tablespoon. 

As stated before, physics should not be adminis- 
tered habitually to children, but if the child should 
have overeaten and should therefore require a cleans 
ing out, a good preparation of cascara, in doses ac- 
cording to the size of the child, in waiter will be the 
santest and, at the same time, the safest remedy. 





FlOURE r»0. SO AT SUPPOSITORY 



Figure 60. fever thermometer 



HOUSEHOLD REMEDIES AND MEASURES 269 

Cathartic pills usually contain irritating drags 

which may so affect the intestine that it will finally 
refuse to fulfil its duty without this unnatural stim- 
ulation. 

Suppositories evacuate only the lower part of the 
bowel, and the popular glycerine suppositories, so 
frequently used for babies, are very likely to irri- 
tate the rectum; inasmuch as they are used for their 
mechanical effect mainly, it is much better, in train- 
ing the baby to use the chamber, to take a piece of 
Castile soap whittled to the proper size (see Fig. 59), 
to dip this into ivhite vaseline and to hold it in the 
rectum for a few seconds. 

Cough medicines either contain opiates and thus 
quiet the natural reflex by which the system intends 
to remove the expectoration from the respiratory 
passages, or they are liable to affect the child's 
stomach. Cough-medicines should not be given to 
children without consulting a physician; the cough 
may be the first sign of a serious disease and valu- 
able time may be lost by their administration. 

Worm-medicines contain a poison for the para- 
sites, and, if given injudiciously, they may also be 
poisonous for the child. The physician should be 
the one to determine if they are really indicated, 
and he is better qualified to prescribe the proper 
dosage than is the manufacturer or the neighbour. 

So-called tonics are also frequently found in the 
medicine closet and they are either administered 
when they are not needed, or valuable time may be 
lost during their administration, when the physician, 



270 THE CHILD IN HEALTH AND ILLNESS 

had he been consulted, could have found some or 
ganic disorder. 

Soaps used for children should be nonirritating, 
first of all, and nothing is better than a good castile 
or a similar soap ; the highly scented and the medi- 
cated soaps are very frequently irritating to the 
child's tender skin. 

The same is to be said about the much-advertised 
ointments, which in many cases keep up the condi- 
tion of the skin for the relief of which they have 
been used; nor is yellow vaseline fit to be used for 
children because it may contain some irritating sub- 
stances. It is much better to use white vaseline, 
which has been purified, if w T e want to use vaseline 
at all ; but, as it is not a fat but a mineral substance, 
its use on the skin is rather more limited than is 
generally recognised. 

Small injuries are best treated without any band- 
ages; when they are exposed to the air a crust of 
clotted blood w T ill form which will offer the best pro- 
tection, while under a bandage and dressings the 
germs have a favourable chance to grow. For 
cleansing the skin around such slight w r ounds plain 
soap and warm water are best, but the wound itself 
must not be touched. Carbolic acid should not be 
used in children, especially not as a wet dressing, 
because children are very susceptible to this poison. 

Larger wounds should be attended to by the phy- 
sician, who can determine the extent of the injury 
and its possible consequences. The careful phy- 
sician will rarely sew up a wound he has not made 




.-•:* 



Figure 61. bronchitis kettle 



Figure 62. improvised bronchitis 

KETTLE 




Figure 63. steam tent 



HOUSEHOLD REMEDIES AND MEASURES 271 

himself at an operation, because the danger is great 
of sewing in some dirt and germs which will inter- 
fere with the healing, and the remaining scar will 
then naturally be larger than it w r ould have been 
otherwise. 

A word also about the mouth-washes, of w r hich 
there are a very large number in the market. They, 
one and all of them, contain many different antisep- 
tics but not enough of any of these to do really any 
good, and plain boiled water, perhaps with the ad- 
dition of a few drops of tincture of myrrh or thymol 
solution, w r ould be preferable. 

Tooth-powders and tooth-pastes which contain 
minute particles of some hard material, such as 
chalk or pumice stone, should be avoided because 
their continued use is sure to wear off the enamel of 
the teeth. 

The toothbrush to be used by the child should be 
of the best of material and of the best quality, so 
that it will not lose its bristles, and it should be soft 
so that it can not injure the gums and thus open 
the road to infectious germs. 

The care of the child's hair will also be very im- 
portant. Cutting of the hair makes it coarse, but it 
does not make it grow, as is popularly believed, nor 
will singeing the hair do any good. In girls the hair 
should not be cut at all, though the split ends of the 
hairs may be clipped off. In boys it is best to keep 
the hair short, even at the loss of the most beautiful 
curls; many a boy has had his disposition spoiled 
by the teasing of his comrades because his fond 



272 THE CHILD IN HEALTH AND ILLNESS 

mother could not make up her mind to have him 
part with these ornaments. The scalp of every child 
should be shampooed twice a week and then slightly 
massaged, but dandruff-cares and hair tonics are 
superfluous, as they will not do any good. The best 
tonic for the scalp is to allow the child to go bare- 
headed. 

A fever-thermometer (see Fig. 60) should be 
found in every family in which there is a child, and 
every mother should learn how to read it. In case of 
illness the mother should know how to take the tem- 
perature of the child in its rectum with the well-oiled 
thermometer. Any considerable fever will tell her 
to send for the physician at once. 

In diseases of the respiratory organs the phy- 
sician will often order the child to have inhalations 
of steam, either with or without the addition of 
some medicine; this is naturally best and easiest 
done with one of the bronchitis kettles (see Fig. 61) 
which can be bought at the drugstore, but it can also 
be done with an ordinar) r tea-kettle and a piece of 
garden-hose or a tube made of paste-board (see 
Fig. 62). A blanket or bed-sheet is draped over the 
child's crib and the end of the apparatus is fastened 
to the bed so that the steam will be confined under 
this steam-tent (see Fig. 63) and thus the air the 
child breathes is saturated with moisture ; care must, 
however, be taken that the steam does not enter too 
near the child so that it might get scalded or that it 
might burn its hands by touching the apparatus. The 
water in the kettle is kept boiling either by a small 








I 



gUi 







■ 



■ 



Figure f>4. wet compress ox baby 



'•,3/ 



1 



A 



~ Li 



<*-& 



I MM 



J 



U ! 



v 









* 



FTGURE 65. WET COMPRESS FOR OLDER CHIED 



HOUSEHOLD REMEDIES AND MEASURES 273 

electric plate, or, where this is not available, by a 
gas or oil-stove. Inhalations of cresoline or forma- 
line and such drugs are, in the writer's opinion, 
useless and they will not take the place of the steam. 

Moist compresses are among the best and most 
effective household remedies, provided they are ap- 
plied in the right way. They consist of a piece of 
cloth dipped in tepid water and w r rung out, a piece 
of oil-silk, guttapercha-paper or oiled paper, which 
should be one inch wider than the moist cloth, and 
finally a flannel bandage or a flannel shirt. For in- 
flammations in the throat and the tonsils the com- 
press should be fastened over the top of the head to 
act on the parts affected; for inflammations in the 
throat lower down the compress is fastened around 
the neck; for the chest, including the windpipe it 
should be applied as follows for babies: a roller- 
towel is folded to the width of from four to six 
inches according to the size of the child, the middle 
of this is placed under the child's back, so that the 
compress reaches well up into the armpits, then it 
is crossed over the breast-bone, folded back over the 
shoulders and fastened on each side of the spine to 
the first layer across the back (see Fig. 64). The oil- 
silk is applied the same way and the whole is kept in 
place by a flannel shirt ; in older children it can also 
be applied according to the method shown in Fig- 
ure 65. Compresses over the abdomen should be 
very carefully applied and fastened because they slip 
up very easily. 

For earache a small hot-water bag or a small bag, 



274 THE CHILD IN HEALTH AND ILLNESS 

lightly filled with table-salt and then heated in the 
oven, will often stop the pain until the physician can 
examine the ear. The hot-water bag is one of the 
handiest things in the household, but few people 
know how it should be filled, and when filled improp- 
erly it will usually not stay in the right place nor do 
much good. The right method to fill a hot-water 
bag is to fill it half full with water at a temperature 
of about one hundred and twenty-five degrees Fah- 
renheit and then slowly to lay it on its side until the 
water is up to the neck of the bag and all the air 
out of it ; in this position the top is then screwed on 
(see Fig. 66). This is also the method of filling ice- 
bags. Both the hot-water bag and the ice-bag should 
not be placed directly upon the skin, but they should 
always be wrapped in a few layers of flannel. The 
mother should make it a practice to hold the hot- 
water bag to her cheek for at least one minute before 
she applies it to the child to avoid nasty burns. In 
his teaching of nurses the writer has insisted that 
the bag should be brought into the sickroom held 
against the check of the nurse. If it is clone this way 
older children will also lose their fear of being 
burned. 

Poultices are applied for the moist heat they give 
off and not for any medicinal action of the material 
from which the poultice is prepared. The old-fash- 
ioned flax-seed poultice will hold the heat longer 
and stay moist longer than any other, and when it 
is carefully wrapped in cheese-cloth or muslin it is 
cleanly and can be changed readily. Two poultices 



I 



f 



■■-.. >::■■■■■ 





Figure 66. filling hot water bag 



HOUSEHOLD REMEDIES AND MEASURES 275 

should be on hand so that 0110 can be re-heated while 
the other is applied. If we intend to draw the 
blood to the skin w^ith the poultice w T e can do 
this best and easiest with a mustard poultice, which 
is made as follows: one or two tablespoons of dry 
mustard powder are mixed with four tablespoons 
of flour; into this a whole egg is broken and 
stirred thoroughly, then hot water, near but not at 
the boiling-point, is mixed in until the poultice be- 
gins to run and the essential oil of the mustard 
begins to irritate the eyes, then it is wrapped up in 
cheese-cloth and applied. To use other material, 
such as spices or onions, and so on, is superfluous. 
The new-fangled, ready-made poultices w r hich are 
sold under various high-sounding names and are 
nothing else than clay mixed with glycerine and a 
few drops of some essential oil, do not hold the 
heat as long as does the good old flax-seed poultice, 
and when they are applied directly to the skin, as is 
usually advised, they are difficult to remove, espe- 
cially when they get into the hair and, moreover, 
they make it difficult for the physician to examine 
the child. 

Cold is best applied in fresh injuries and in acute 
conditions ; heat, in chronic inflammations. 

Ointments are used for two purposes, either to 
cover the skin or to be rubbed into it. When used 
to cover tlie skin, in skin-diseases, or to protect dis- 
eased and injured parts, then the ointment should 
be applied not less than one-six:teenth of an inch 
in thickness. If prescribed for the action of the 



276 THE CHILD IN HEALTH AND ILLNESS 

medicinal properties of the drugs contained in the 
ointment, small quantities should be used at a time 
and thoroughly rubbed into the skin, so that it can 
be absorbed. 

When the physician has ordered an enema, an in- 
jection into the bowel, this is best given with a soft 
rubber catheter, which is well oiled and with a glass 
funnel fastened to this, to pour in the warm water 
(see Fig. 67) ; if a fountain-syringe is used for this 
purpose it should be so held that its lower portion is 
not more than six inches above the child's rectum. 
If the fountain-syringe should be held too high 
and the pressure under which the enema is given 
should be more than twelve inches, then the liquid 
will cause the internal closing muscles of the rectum 
to contract, the liquid will stay in this part of the 
bowel, ballooning it up, and, it will give the patient 
considerable pain and discomfort, while when it is 
done with low pressure the liquid will sneak in, so to 
say, and it will thus reach the upper bowel, where it 
is intended to go. 

For the rapid emptying of the lower bowel the 
writer advises an enema made as follows: a table- 
spoonful of each, grated castile soap and castor oil 
are mixed thoroughly and into this a pint of warm 
w r ater is slowly stirred ; this should not be employed 
more than once or at most twice. 

Wet packs are the best and at the same time the 
safest means of reducing fever, and they are em- 
ployed with great benefit in quieting children suf- 
ng from nervous excitation. They are also used 




I 



FTGURE 6 7. ENEMA 



HOUSEHOLD REMEDIES AND MEASURES 277 

to relievo congestions of internal organs, especially 
of the lungs. A sheet is wrung out of cool or hot 
water, as the case may be; this is spread over a 
heavy woollen blanket, then the child is carefully 
wrapped up in these, so that one end of the sheet 
goes around the body under the armpits and the 
other end over the shoulders, then the blanket is 
tucked around the child (see Fig. 68). Infants may 
remain in the pack for from ten to thirty minutes, 
older children up to one hour. Then they are taken 
out, rubbed until they are quite dry and wrapped in 
a dry, warm blanket for two or three hours longer. 
In relieving congestion of the lungs a mustard 
pack can not be surpassed in effectiveness. To pre- 
pare this a large cup of dry mustard powder is 
mixed with a quart of warm water to form a thick 
soup, the smelling of wdiich makes the tears come to 
the eyes of the one who prepares it ; into this a sheet 
is dipped, in which, the child is WTapped in the same 
manner as in an ordinary wet pack. The child re- 
mains in the mustard pack not less than twenty 
minutes, then it is sponged off quickly with warm 
water and placed in an ordinary warm pack for two 
hours. After the mustard pack the skin of the child 
should be the colour of a boiled lobster. This mus- 
tard pack can not be given more than once a day, 
but even in severe cases of pneumonia one of these 
packs may be the means of saving a child's life; or- 
dinary wet packs may be administered several times 
a day. Needless to say that the child has to be 
watched constantly while in a pack, and, if neces- 



278 THE CHILD IN HEALTH AND ILLNESS 

sary, a cold cloth should be applied to its head. 

The most important point in the application of 
compresses as well as of packs is that the child 
should react ; that means that the blood should really 
be drawn into the skin. If the child should not thus 
react the procedure does no good and should not be 
repeated. It is quite easy to find out if a compress 
is having the desired result by slipping a finger un- 
der it. When the skin under the compress is hot and 
moist this shows that it is doing good, if on the 
other hand it should feel cold and clammy it should 
be removed at once. 

Full baths are given not only for cleansing pur- 
poses, but they are also of medicinal value when we 
add various drugs to the water. The temperature 
of the bath must be measured with the bath-ther- 
mometer and the degree of the temperature must 
be left to the physician. Cold affusions in the hot 
bath are of great value in diseases of the respira- 
tory organs. The child is placed in a hot bath for 
from three to five minutes, then it is lifted up and 
cold water is poured over its chest and back and 
shoulders with a tumbler or a small pitcher, then 
the child is at once taken from the bath and dried 
thoroughly. 

The two kinds of baths most in use are the bran 
bath and the salt bath. For a bran bath, which is 
beneficial in many forms of irritation of the skin, 
a pound of bran is placed into a muslin bag and 
hot water is allowed to stand over it for some min- 
utes, then the bath is filled to the desired height 




ttr 





u 




Figure 68, wet pack 



HOUSEHOLD REMEDIES AND MEASURES 279 

and temperature and the bag kneaded in it until 
the water becomes milky. Salt baths are much used 
in and seem to be of benefit for scrofular children. 
They are best prepared with sea-salt which may be 
obtained at the drug stores; of this six ounces are 
used to each five gallons of water. Other medicinal 
baths must be prepared strictly according to the 
directions of the physician. 



CHAPTER XVIII 
EECIPES OF DISHES FOR CHILDREN 

FOR INFANTS 

T^ARLEY WATER. One-half ounce of whole 
JD barley (1 level tablespoonful) is washed and 
then ground in a coffee-mill; it is then cooked in a 
double boiler with one and one-half pint of fresh 
water for two hours and allowed to drain through a 
piece of cheese-cloth ; it must then be brought up to 
one pint by the addition of boiled water. One of the 
barley flours made from the ivhole grain may be 
used, and it has to cook then for only twenty min- 
utes.* 

Oatmeal Water. One-half ounce of rolled oats 
(1 highly heaped tablespoonful) is washed and then 
cooked in a double boiler with one and one-half pint 
of fresh water for two hours and allowed to drain 
through a piece of cheese-cloth, it must then be 
brought up to one pint by the addition of boiled 
water. One of the oat flours made from the ivhole 

* The author has found the barley, oat and soy bean gruel 
flours and the malt called Cereo, all manufactured by the Cereo 
Company of Tappan, N. Y., to be the best and cheapest, and his 
chemical analyses correspond to those of the manufacturers. 

280 



RECIPES OF DISHES FOR CHILDREN 281 

irrain may bo used and it lias to cook then for 
only twenty minutes.* 

Barley Gruel. One ounce of barley (2 level table- 
spoonfuls) is washed and then ground in a coffee- 
mill; it is then cooked in a double-boiler for two 
hours with one and one-half pint of fresh water; it 
is then strained through a piece of cheese-cloth or a 
hairsieve and brought up to a pint by the addition 
of boiled water. One of the barley flours made from 
the whole grain may be used, when it has to cook 
only for twenty minutes ; in this case it need not be 
strained after the child is six months old.* 

Oat Gruel. One ounce of rolled oats (2 highly 
heaped tablespoonfuls) is washed and then cooked 
in a double-boiler with one and one-half pint of fresh 
water for two hours; it is then strained through a 
piece of cheese-cloth or a hairsieve and brought up 
to a pint by the addition of boiled water. One of 
the oat flours made of the whole grain may be used, 
when it has to cook only for twenty minutes ; in this 
case it need not be strained after the child is six 
months old.* 

Rice Gruel. Two tablespoonfuls of rice are 
soaked over night in eight ounces of water, cooked 
over a slow fire for two hours in the same water and 
then strained through a hairsieve. 

Dextrinised Gruel. The gruel is prepared as de- 

* The author has found the barley, oat and soy bean gruel 
flours and the malt called Cereo, all manufactured by the Cereo 
Company of Tappan, N. Y., to be the best and cheapest, and his 
chemical analyses correspond to those of the manufacturers. 



282 THE CHILD IN HEALTH AND ILLNESS 

scribed above; it is then allowed to cool down to 
blood temperature, about one hundred degrees Fah- 
renheit, then a teaspoonful to a tablespoonful of an 
active malt-preparation is stirred in. It is much 
easier to strain after it has been dextrinised, as the 
process makes even a thick gruel thin and watery. 

Soy Bean Gruel. One-half ounce of soy bean flour 
is cooked with the gruel in addition to the cereal.* 

Skim Milk. A quart of fresh pure milk is allowed 
to stand on ice for three or four hours. When the 
cream has all risen this is either taken off with a 
small dipper or the milk may be syphoned out from 
underneath the cream with a bent glass tube by suc- 
tion or by pressure from above. 

Bulgarian Buttermilk. As the buttermilk in the 
market varies considerably in acidity, it is prefer- 
able to prepare it at home. One quart of skim 
milk is boiled so that all the bacteria in it will be 
killed. It is then allowed to cool clown to blood 
heat, about one hundred degrees Fahrenheit, and a 
pure culture of lactic acid bacteria, either in tablet 
or in liquid form, is added, and the milk is allowed 
to stand at room temperature, at from sixty to 
seventy degrees Fahrenheit, for twenty-four hours. 
It will then be ready for use. To make the butter- 
milk after this it is only necessary to keep an ounce 

* The author has found the barley, oat and soy bean gruel 
flours and the malt called Cereo, all manufactured by the Cereo 
Company of Tappan, N. Y., to be the best and cheapest, and his 
chemical analyses correspond to those of the manufacturers. 



RECIPES OF DISHES FOR CHILDREN 283 

of it from the day before to be added to the freshly 
boiled milk. 

Buttermilk Soup. The amount of wheat-flour and 
granulated sugar prescribed by the physician is 
placed into a saucepan, preferably of aluminum and 
holding two quarts, and stirred into a batter with 
one-half pint of cold water. It is then put on the 
fire and the buttermilk added slowly in small 
amounts until lumps will no longer form; then the 
rest of the quart of buttermilk is added and the 
whole brought to the boiling point under constant 
stirring. As soon as it begins to boil up it is with- 
drawn from the fire and this is repeated twice more. 

Albumin Milk. One quart of fresh milk is boiled 
for five minutes and cooled to blood heat, one hun- 
dred degrees Fahrenheit, then a teaspoonful of Chy- 
mogen (Armour and Co.) or a similar preparation 
is stirred in and the milk allowed to stand for one 
hour at this temperature. It is then strained 
through a clean, freshly boiled cheese-cloth bag and 
allowed to drip for one and one-half to two hours; 
the solid curd is then forced through a hairsieve 
with a potato-masher twice with one pint of butter- 
milk, and then enough boiled water is added to bring 
the whole up to one quart, beating it vigorously in 
a small churn. The amount of sugar to be added to 
this must be prescribed by the physician. Before 
giving this albumin milk it must be shaken well 
and it must be heated very carefully to prevent the 
formation of large curds which can not pass through 



284 THE CHILD IN HEALTH AND ILLNESS 

the nipple. No other food, except breast-milk can 
be given with this milk. 

Home-made Malted Milk. A home-made malted 
milk which has been used very successfully by the 
writer is made as follows : a pint of fresh milk is 
heated to blood temperature, one hundred degrees 
Fahrenheit, and three-quarters of a tube of pepto- 
genic milk powder, or a similar preparation, is 
stirred into it; it is then allowed to stand at the 
same temperature for ten minutes. Then it is 
brought to boiling and one pint of dextrinised gruel 
is added. 

Orange Juice. A sweet ripe orange is cut in two 
and the juice expressed and strained through a piece 
of cheese-cloth. If the orange should not be sweet 
enough a small pinch of bicarbonate of soda, not 
sugar, will remedy this. 

Orange Peel Water. The medicinal action of 
orange peel water is quite as good as that of orange 
juice ; it is made as follows : the peel of a ripe orange 
is grated and two tablespoonfuls of this is steeped 
with four tablespoonfuls of w r ater and strained 
through a piece of cheese-cloth; to cover the bitter 
taste one-quarter of a one-grain saccharine tablet 
is added. 

Potato Water. A medium-sized potato is boiled 
in Bait-water. AYhen it is thoroughly cooked the 
water is drained off and the pot is put on the fire 
again, to make the potato mealy; then it is peeled 
and mashed. Two heaped tablespoonfuls of this are 
stirred into one pint of water. 



RECIPES OF DISHES FOR CHILDREN 285 

Grated Apple. A sound, ripe, sweet apple is 
peeled and then grated on a vegetable grater to a 
very fine pulp. 

Farina Pap. One cup of milk, eight ounces, is 
put into a sauce-pan, preferably of aluminum, and 
brought to the boiling point, then two teaspoonfuls 
of farina are stirred in slowly and this is allowed to 
boil under constant stirring until thick. 

Zwieback Pap. Three or four zwieback are rolled 
with a rolling pin into fine crumbs and then boiled 
with one cup, eight ounces, of milk, until thick. In- 
stead of the zwieback three slices of dry toast may 
be used. 

Dry Toast. Stale wheat bread is cut into slices 
one-quarter inch thick, put in a bread-pan and 
roasted in the oven with a slow fire until the bread 
is a golden brown. 

Arrow-Root Pap. One cup of fresh milk, one- 
half pint, is put into a sauce-pan and one teaspoon- 
ful of arrow-root is stirred into this, then it is boiled 
under continuous stirring until thick. 

Vegetable Soup. Two ounces of carrots (one me- 
dium-sized carrot), two ounces of potatoes (one 
small potato), one ounce of turnips (one-half of a 
small turnip), one ounce (one handful) of spinach or 
lettuce leaves, one ounce (one heaped tablespoonful) 
of dried beans, split peas, lentils or of pearl barley, 
one-half teaspoonful of salt and one quart of fresh 
water are put into a stew-pan; this is well covered 
and allowed to simmer for four hours on the back 
of the stove or in a tireless cooker, then it is strained 



286 THE CHILD IN HEALTH AND ILLNESS 

through a hair sieve and brought up to one quart 
with boiled water. Before feeding it is thickened 
by crumbling up some dry toast into it. 

FOR YOUNG CHILDREN 

Spinach or Lettuce. Eight ounces, one peck of 
young fresh spinach or two small heads of lettuce 
are washed three times in fresh cold water and 
boiled for about five minutes with a pinch of salt. 
As soon as the leaves are thoroughly cooked they 
are minced very finely; then the minced leaves are 
strained twice through a hairsieve and heated up 
quickly with one-half teaspoonful of fresh butter. 

Mashed Potatoes. Eight ounces of peeled po- 
tatoes (one large potato), are boiled with one tea- 
spoonful of salt and sufficient water until they are 
cooked through. This will take not less than one- 
half hour, then the water is drained off and the po- 
tatoes are dried in the oven for a few minutes ; they 
are now strained through a hairsieve, one-half tea- 
spoonful of fresh butter and four ounces of milk 
stirred in and the whole cooked on a slow fire. 

Mashed Carrots. Six ounces (one or two bun- 
dles) of fresh young carrots are washed in cold wa- 
ter and scraped clean; they are then cut into disks 
and cooked with one-half pint of fresh water and 
one-half teaspoonful of salt for three-quarters of an 
hour. They are now drained ; the drained-off water 
is boiled down considerably and the carrots strained 
with this through a hairsieve, then one-half tea- 



RECIPES OF DISHES FOR CHILDREN 287 

spoonful of fresh butter and one-quarter teaspoon- 
ful of granulated sugar is stirred in and the whole 
boiled on a slow fire. 

Mashed Chestnuts. One-half pound of ripe Span- 
ish chestnuts are peeled and then boiled up quickly 
in water to remove the inner peel. One-half pint of 
fresh milk is brought to a boil and the chestnuts 
cooked in this for one hour ; they are then strained 
through a hairsieve and cooked on a slow fire with 
one-half teaspoonful of salt and one-half teaspoon- 
ful of butter. 

Mashed Peas. One pound of green peas are 
shelled, placed in a pot with four ounces of water, 
one-half teaspoonful of salt and one-half teaspoonful 
of granulated sugar, cooked for one-half hour over a 
slow fire, strained through a hairsieve and cooked 
quickly over a slow fire with one-half teaspoonful of 
fresh butter. Instead of the green peas eight ounces 
(one-half cupful) of dried peas, beans or lentils are 
soaked over night and cooked in the same manner. 

Milk Rice. Two ounces (two heaped tablespoon- 
fuls) of washed rice are boiled for one hour in three- 
quarters of a pint of milk with one tablespoonful of 
sugar and one-half teaspoonful of salt. 

Prune Pulp. One pound of dried prunes are put 
in a pot and covered with fresh cold water, they are 
then brought to the boiling point ; the water is then 
drained off and replaced with fresh water. This is 
done three times in all. Then one-half pint of fresh 
water is added and they are boiled over a slow fire 



288 THE CHILD IN HEALTH AND ILLNESS 

for one hour, replacing the water as it boils off. 
Then they are strained through a hairsieve. 

Stewed Bananas. Two bananas are peeled and 
stewed whole for five minutes in one ounce of 
browned butter, turning them over a few times. 
They are then placed into a covered casserole with 
three ounces of milk and stewed for fifteen minutes 
over a slow fire. 

Mashed Bananas. Two bananas are peeled and 
sliced and boiled for ten minutes in one-half pint of 
milk; then they are cooked up quickly wdth one- 
quarter teaspoonful of salt and one teaspoQnful of 
granulated sugar and strained through a hairsieve. 

Apple Sauce. One-half pound of apples (two 
small apples) are washed and sliced and they are 
then stewed for fifteen minutes with three ounces 
of cold water and two teaspoonfuls of granulated 
sugar and strained through a hairsieve. 



INDEX 



INDEX 



Adenoids, 221 

Affusions, cold, 278 

Albumen milk, 283 

Alcohol, 150 

Alimentary intoxication, 106 

Anemia in childhood, 217 

in breast-babies, 91 
Angina, 225 

Antitoxin for diphtheria, 197 
Antivaccinationists, 180 
Appendicitis, 234 
Appetite in childhood, 232 

in contagious diseases, 212 
Apple, grated, 285 
Apple sauce, 288 
Arctics, 156 
Arrow-root pap, 285 
Asthma in childhood, 229 
Astigmatism, 255 
Atrophy, 107 

B 

Baby scales, 83 

-talk, 162 

-yard, 60 
Backwardness, 167 
Bananas, 288 
Barley guel, 281 

water, 280 
Bath of newborn, 36 
Bathing infants, 45 

newborn daily, 44 
Baths during pregnancy, 19 

medicinal, 278 



Bath-thermometer, 38 
Bed for babies, 55 

for sick child, 214 

-wetting, 245 
Bladder, inflammation of, 240 
Bleeders, 220 
Blind baby, 260 
Blindism, 263 
Blindness, 258 
Blood, diseases of, 219 

examination of, 219 

in stools of newborn, 34 

-vessels, exercise of, 175 
Bloomers, 154 
Blue babies, 222 
Boils, 128 

Bones, diseases of, 247 
Bowels, in contagious diseases, 212 
Brain fever, 204 

tumor, 243 
Bran-bath, 278 
Breast-feeding, 65 

failure to do so, 66 
Breast-glands, swelling of in new- 
born, 35 
Breast-milk, amount of, 72 

amounts taken, 86 

cream in, 87 

examination of, 87 

for premature, 119 

in boils, 128 

in syphilis, 131 
Breast-nipples, drawing out of, 69 

during pregnancy, 21 

in girls, 68 



291 



292 



INDEX 



Breast-pumps, 80 

I fcreast -shields, 78 

i breast -stool, 30 

Breasts, swelling of, in newborn, 71 

Breck-feeder, 120 

Bronchial tubes, diseases of, 227 

Bronchitis, in childhood, 228 

in infancy, 127 

kettle, 272 
Bronchopneumonia, 230 
Buggy, 57 

Bulgarian buttermilk, 282 
Buttermilk, 101 
Buttermilk-soup, 283 



Care of cord, 40, 43 

Caloric demands of child, 145 

requirements of baby, 99 

value of foods, 149 
Calory, 25 
Candy, 151 

Carbohydrates, 100, 143 
Carrying baby, 64 

young infant, 64 
Cattle for baby's milk, 101 
Changes in newborn, 26 
Chestnuts, 287 
Chest of newborn, 27 
Chickenpox, 193 
Cholera infantum, 106 
Chorea minor, 203 
Circumcision, 241 
Clothes-basket as bed, 55 
Clothing of infants, 50 
Coffee, 150 
Cold in the head, 125 
Cold-sores, 231 
Colic-cures, 268 
Combined feeding, 89 



Comparison of scarlatina and 

measles, 191 
Complications of vaccination, 182 
Compresses, 273 
Constipation during pregnancy, 20 

in childhood, 232 

in infancy, 122 
Constitution, 109 
Contamination of cows' milk, 95 
Convulsions in childhood, 243 

in infancy, 135 
Coryza in childhood, 223 

in infancy, 125 
Cough medicines, 269 
Course of vaccination, 181 
Cowpox, 179 
Cows' milk, 95 
Cracked nipples, 78, 86 
Cradle, 56 
Crawling, first, 31 
Cross-eye, 254 
Crying at stool, in infancy, 123 

in bath, 38 

in infants, 30 

in rickets, 133 

of baby, 48 

of newborn, 34 

of premature, 117 
Cystitis, 240 



Dancing, 169 
Decomposition, 107 
Defects of speech, 162 
Dentition, first, 32 

second, 139 
Dextrinized gruel, 281 
Diaper, 51 
Diarrhea in childhood, 234 

in infancy, 123 



INDEX 



2<»3 



Diet of nursing mother, 42, 82 
Digestive disturbances of infantSj 
100 

Digestive organs, diseases of, 231 
Diphtheria, 194 

antitoxin, 197 

inoculation against, 186 
Discharge from eyes, 35 
Dishes in contagious diseases, 215 
Disinfection, 177 

in contagious diseases, 217 
Dislocations, 246 
Dropsy, 240 

Drying infant after bath, 47 
Dyspepsia in babies, 106 

in childhood, 233 



Eczema in infancy, 135 
Education of child, 158 

of infant, 61 
Enema, 276 
Empyema, 231 

Epidemic cerebro-spinal meningi- 
tis, 204 
Epilepsy, 243 
Evening parties, 169 
Examinations, school, 168 
Exercise, during pregnancy, 17 
Experience, 164 
Excreta, in contagious diseases, 

215 
Eyes, examination of, in newborn, 
253 

in childhood, 252 

in contagious diseases, 216 

of newborn, 31 
Eye-strain, 255 



Fainting spells, 243 



Farina pap, 91, 285 

Farsightedness, 255 

Fat, 100 

Feeding of newborn, 41, 143 

Fever-hospitals, 177 

Fever-thermometer, 272 

Fissure at anus, in childhood, 263 

in infancy, 123 
Fixing objects, 31 
Flannel binder, 53 
Fontanel, closing of, 32 
Fontanels, 27 
Food, during pregnancy, 18 

in contagious diseases, 216 
Foreign bodies, 248 
Foreskin, tight, 241 
Fractures, 245 



Gain of infants, 26 
Gastro-intestinal infection, 108 
Genital organs, infection of, 241 

in mumps, 212 
Geographic tongue, 231 
German measles, 192 
Germs in cows' milk, 96 
Glands in angina, 226 

in diphtheria and scarlatina, 211 
Glandular fever, 227 
Glioma, 256 

Grasping, first attempt at, 30 
Grippe in infancy, 124 

in measles and whooping cough, 
210 
Growing pains, 203 
Growth during childhood, 138 
Gums, applications to, 114 



Hair, 271 



294 



INDEX 



Hammock, 57 
Hardening, 175 
Head of newborn, 24 
Health-laws, 176 
Hearing of newborn, 31 
Heart, diseases of, 221 

in contagious diseases, 211 
Heat, effect of, 108 

loss in premature, 116 
Hernia, 235 
Herpes, 231 
High chair, GO 
Hot-water bag, 273 
Hospital-bed, 214 
Household remedies, 267 
Human milk compared with cows' 

milk, 94 
Hydrophobia, inoculation against, 

184 
Hyperopia, 255 
Hysteria, 244 

I 
Incubation, 188 
Incubators, 118 
Infantile paralysis, 206 
Infections, general, 108 

of eyes of newborn, 35 
Inflammation of mouth in infancy, 

123 
Injuries, 270 
Intubation, 211 

j 

Jaundice, catarrhal, 238 
of newborn, 34 

K 

Keeping clean, 159 
Keeping up head, 30 
Kicking of baby, 54 



Kidneys, diseases of, 239 
during pregnancy, 20 
in contagious diseases, 212 

Kindergartens, 166 



Lancing of gums, 114 

Lanugo, 27 

Length of newborn, 27 

Lettuce, 286 

Lifting up head, 30 

Liquid needed by baby, 98 

Liver, diseases of, 238 

size of, 29 
Loss in newborn, 26 
Lungs, diseases of, 230 

of newborn, 34 
Lymphatism, 134 

M 

Malformations of bones, 248 
Malted milk, home-made, 284 
Masturbation, 241 
Meals, number of. 144 
Meconium, 29 
Membranous croup, 199 
Measles, 190 
Meningitis, 241 

epidemic, 204 
Middle ear, infection in infancy, 
127 

in contagious diseases, 211 
Milk, boiling of, 101 

modification of, 97 

-rice, 287 

-teeth, 32 
Miscarriages, 22 

Morning-sickness, during preg- 
nancy, 19 
Mother's milk, 65 



INDEX 



295 



rfouth, cleaning of, 48 

diseases of, in childhood, 231 

in contagious diseases, 210 

-washes, 271 
doving pictures, 170 
dumps, 201 
shisic lessons, 169 
dustard pack, 277 

poultice, 275 

N 

Natural food, 65 

S avel, infection of, 35 

Nervous system, diseases of, 241 

Nervous vomiting, 232 

fright-drawers, 155 

■gown for babies, 55 

■terrors, 244 
Sose, in contagious diseases, 216 
Nursery, 58 
Nursing-bottles, 103 

during menstruation, 77 

four hour interval, 73 

in bed, 69 

length of, 71 

number of, 72 

objections to, 77 

record, 86 

results of, 83 

in sitting posture, 70 

twins, 90 
Nystagmus, 253 



Oat gruel, 281 
Oatmeal water, 280 
Ointments, 270, 275 
Only children, 141 
Orange- juice, 91, 284 
Orange peel water, 284 



Overfeeding, 106 
onesided, 107 



Pacifier, 48 
Pajamas, 155 

Paralyses, after diphtheria, 212 
Parasites, 237 
Patented foods, 97 
Peas, 287 
Pertussis, 199 
Phimosis, 241 

Phlyctenular ophthalmia, 256 
Physics, 268 
Pinning-blanket, 53 
Placarding of houses, 176 
Platform scales, 83 
Play, 163 
Pleurisy, 230 

Pneumonia in contagious diseases, 
210 

in infancy, 127 

lobar, 230 
Poisons, 250 
Potatoes, 286 
Potato-water, 284 
Poultices, 274 
Powdering baby, 50 
Premature infant, 115 
Prevention of contagious diseases, 
171 

infection of eyes, 35 
Prodromata, 188 
Prolapse of rectum, 236 
Prophylaxis of contagious diseases, 

172 
Proteins, 100, 143 
Prune pulp, 287 
Pseudocroup, in infancy, 126 

in childhood, 227 



296 



INDEX 



Pulse of newborn, 33 
Putting infant dry, 49 



Quarantine, I7i> 
Quincy, 220 



Rachitis, 131 
Rectum, diseases of, 236 
Respirations of newborn, 33 
Retropharyngeal abscess, 226 
Rheumatism, inflammatory, 202 

scarlatinal, 213 
Rice gruel, 281 
Rickets, 131 

Ring for head, 56 

Rompers, 154 

Room, temperature of, 58 

Round worm, 237 

Rubbers, 156 

Rubeola, 192 

Rupture, 235 



St. Vitus' dance, 203 
Salt-bath, 279 

Salts in food, 144 
Sandals, 156 
Scalp of infant, 47 
Scarlet fever, 187 
School for blind, 265 
-anemia, 220 
-vomiting, 220 
Schooling, 1(>() 
Scoop scales, 83 
Scraped apple, 91 
Scurvy, 133 
Shirt for baby, 53 
Shoes for children, 156 
for infants, 53 



Sitting up first, 31 
Skeleton, diseases of, 245 

Skimmilk, 101, 2S2 

Skin in contagious diseases, 216 

irritation of, in infancy, 128 
Skull of newborn, 27 
Sleeping bag, 54 
Smile, first, 31 
Soaps, 270 

for infants, 46 
Soothing syrups, 268 
Soy-bean gruel, 282 
Spasmodic croup, 120 
Spasms, 244 
Speech, 161 
Spices, 150 
Spinach, 286 
Spinal puncture, 242 
Spine, curvature of, 248 
Spitting up, 28 
Spoiled stomach, 233 
Standing, first, 31 
Starches, 100 
Steam inhalations, 272 
Stomatitis, 122 
Stools of infants, 30 

of newborn, 29 
Strabismus, 254 
Strengthening diet, 151 
Sugars, 100 
Suppositories, 269 
Surface of newborn, 24 
Suspenders, 155 
Syphilis in infancy, 130 



Tape worm, 237 
Tea, 150 
Teaching, 165 
Tears, first, 31 



INDEX 



297 



Teething, 112 

-medicines, 113 
Teeth, cause of decay, 145 

during pregnancy, 19 

first, 32 

permanent, 139 
Temperature, of bath, 45 

of newborn, 33 
Tetanus, inoculation against, 1S4 
Theatres, i70 
Thread-worms, 237 
Throat, diseases of, 227 
Thrush, 123 
Tics, 244 
Toast, 285 
Tonics, 269 
Tonsillitis, 226 
Tooth-brush, 271 
Tooth-powders, 271 
Toys for baby, 61 
Tracheitis, 227 
Tracheotomy, 211 
Training of blind child, 264 
Treatment of vaccination, 183 
Tubercular glands, 228 

meningitis, 242 
Tuberculosis, 207 

after contagious diseases, 210 

in childhood, 235 

in infancy, 129 

in nursing mother, 78 

of bones, 247 
Typhoid fever, inoculation against, 
185 



Umbilical cord, 29 
Underfeeding, 107 



Unnatural feeding, 93 

food, 65 
Trine, during pregnancy, 20 

examination of, 239 

of newborn, 29 



Vaccination, 178 
Varicella, 193 
Vegetable soup, 92, 285 
Vomiting of blood in newborn, 34 

W 

Waist for young girls, 156 
Walking, first, 31 
Walking-pen, 60 
Washing face of newborn, 39 

eyes of newborn, 39 
Weaning, 90, 143 

gradual, 92 
Weight-charts, 84 

curve, 84 

in childhood, 138 

of newborn, 26 

of premature, 117 
Wetnursing, 80 

dangers of, 81 

modern method, 82 
Wet packs, 276 
Wliooping cough, 199, 21G 

inoculation against, 186 
Windpipe, diseases of, 227 
Wiping out mouth, 44 
Witch's milk, 35 
Worm medicines, 269 
Worms, 237 

Z 

Zwieback pap, 91, 285 



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) 10 11 is 13 I4 






















































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































WEIGHT-CHART of _ Born J9 

years: } 2 3 4 5 6 7 






<b 



& 



LIBRARY OF CONGRESS 



022 169 354 1 



